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

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..

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Cohort flow diagram. Abbreviations: ART, antiretroviral therapy; HBV, hepatitis B virus; HIV, human immunodeficiency virus; LTFU, lost to follow-up; TE, transient elastography.

Figure 2.

Change in liver stiffness during the initial year of antiretroviral therapy among human immunodeficiency virus–infected adults in Zambia, by hepatitis B virus coinfection status. Abbreviations: HBV, hepatitis B virus; HIV, human immunodeficiency virus.

Figure 3.

Association between human immunodeficiency virus (HIV) and hepatitis B virus (HBV) viral suppression at 1 year on antiretroviral therapy among HIV–HBV-coinfected adults. Abbreviation: HIV, human immunodeficiency virus.