Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared

Int J Infect Dis. 2016 Oct;51:97-102. doi: 10.1016/j.ijid.2016.08.028. Epub 2016 Sep 3.


Objective: To examine the association between hepatitis B virus (HBV) infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland.

Methods: HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland were included. Liver fibrosis was evaluated using the aspartate aminotransferase-to-platelet-ratio index (APRI), with a ratio >1.5 defining significant fibrosis and a ratio >2.0 indicating cirrhosis. The association between hepatitis B surface antigen (HBsAg) positivity, HBV replication, and liver fibrosis was examined using logistic regression.

Results: In Zambia, 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2058 in Switzerland. HBsAg-positive patients were more likely to have significant liver fibrosis than HBsAg-negative ones: the adjusted odds ratio (aOR) was 3.25 (95% confidence interval (CI) 1.44-7.33) in Zambia and 2.50 (95% CI 1.19-5.25) in Switzerland. Patients with a high HBV viral load (≥20000 IU/ml) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with an undetectable viral load: aOR 3.85 (95% CI 1.29-11.44) in Zambia and 4.20 (95% CI 1.64-10.76) in Switzerland. In both settings, male sex was a strong risk factor for significant liver fibrosis.

Conclusions: Despite the differences in HBV natural history between Sub-Saharan Africa and Europe, the degree of liver fibrosis and the association with important risk factors were similar.

Keywords: HIV; Hepatitis B infection; Liver fibrosis; Switzerland; Zambia.

MeSH terms

  • Adolescent
  • Adult
  • Aspartate Aminotransferases / metabolism
  • Blood Platelets / metabolism
  • Cohort Studies
  • Coinfection
  • Cross-Sectional Studies
  • Female
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • HIV Infections / virology
  • Hepatitis B / complications*
  • Hepatitis B / epidemiology
  • Hepatitis B / virology
  • Hepatitis B Surface Antigens / analysis*
  • Hepatitis B virus / genetics*
  • Hepatitis B virus / immunology
  • Hepatitis B virus / physiology
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Risk Factors
  • Switzerland / epidemiology
  • Viral Load
  • Young Adult
  • Zambia / epidemiology


  • Hepatitis B Surface Antigens
  • Aspartate Aminotransferases