Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia

Clin Infect Dis. 2017 May 15;64(10):1343-1349. doi: 10.1093/cid/cix122.

Abstract

Background: We investigated changes in hepatic fibrosis, based on transient elastography (TE), among human immunodeficiency virus (HIV)-infected patients with and without hepatitis B virus (HBV) coinfection on antiretroviral therapy (ART) in Zambia.

Methods: Patients' liver stiffness measurements (LSM; kiloPascals [kPa]) at ART initiation were categorized as no or minimal fibrosis (equivalent to Metavir F0-F1), significant fibrosis (F2-F3), and cirrhosis (F4). TE was repeated following 1 year of ART. Stratified by HBV coinfection status (hepatitis B surface antigen positive at baseline), we described LSM change and the proportion with an increase/decrease in fibrosis category. Using multivariable logistic regression, we assessed correlates of significant fibrosis/cirrhosis at 1 year on ART.

Results: Among 463 patients analyzed (61 with HBV coinfection), median age was 35 years, 53.7% were women, and median baseline CD4+ count was 240 cells/mm3. Nearly all (97.6%) patients received tenofovir disoproxil fumarate-containing ART, in line with nationally recommended first-line treatment. The median LSM change was -0.70 kPa (95% confidence interval, -3.0 to +1.7) and was similar with and without HBV coinfection. Significant fibrosis/cirrhosis decreased in frequency from 14.0% to 6.7% (P < .001). Increased age, male sex, and HBV coinfection predicted significant fibrosis/cirrhosis at 1 year (all P < .05).

Conclusion: The percentage of HIV-infected Zambian adults with elevated liver stiffness suggestive of significant fibrosis/cirrhosis decreased following ART initiation-regardless of HBV status. This suggests that HIV infection plays a role in liver inflammation. HBV-coinfected patients were more likely to have significant fibrosis/cirrhosis at 1 year on ART.

Clinical trials registration: NCT02060162.

Keywords: Africa; HIV/AIDS; hepatitis B virus; liver fibrosis; transient elastography..

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active* / adverse effects
  • Benzoxazines / administration & dosage
  • Benzoxazines / adverse effects
  • Benzoxazines / therapeutic use
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Coinfection / drug therapy*
  • Coinfection / virology
  • Elasticity Imaging Techniques
  • Emtricitabine / administration & dosage
  • Emtricitabine / adverse effects
  • Emtricitabine / therapeutic use
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / virology
  • Hepatitis B / complications*
  • Hepatitis B / drug therapy*
  • Hepatitis B / pathology
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / isolation & purification
  • Hepatitis B virus / physiology
  • Humans
  • Liver / pathology
  • Liver / physiopathology
  • Liver / virology
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / virology*
  • Logistic Models
  • Male
  • Prospective Studies
  • Viral Load / drug effects
  • Zambia / epidemiology

Substances

  • Anti-HIV Agents
  • Benzoxazines
  • Hepatitis B Surface Antigens
  • Emtricitabine
  • efavirenz

Associated data

  • ClinicalTrials.gov/NCT02060162