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Abstract
Background. We evaluated the prevalence of chronic hepatitis B virus (HBV) infection and liver fibrosis/cirrhosis in human immunodeficiency virus (HIV)-infected individuals enrolled in a rural Tanzanian prospective cohort and assessed hepatic fibrosis progression 12–24 months after antiretroviral treatment (ART) initiation.
Methods. All ART-naive HIV-infected adults ≥15-year-old enrolled in the Kilombero and Ulanga Antiretroviral Cohort who started ART between 2005 and 2015 were included. Pre-ART factors associated with significant liver fibrosis (aspartate aminotransferase-to-platelet ratio index [APRI] >1.5) and cirrhosis (APRI > 2.0) were identified using logistic regression.
Results. Of 3097 individuals screened, 227 (7.3%; 95% CI, 6.4–8.2) were hepatitis B surface antigen (HBsAg) positive. Before ART initiation, 9.1% individuals had significant liver fibrosis and 5.3% had cirrhosis. Human immunodeficiency virus/HBV-coinfected individuals were more likely to have an APRI score indicating significant fibrosis (14.2% vs 8.7%, P = .03) and cirrhosis (9.2% vs 4.9%, P = .03) than HBV-uninfected patients. CD4 cell count <200 cell/μL and alcohol consumption were independently associated with pre-ART APRI score, indicating significant fibrosis and cirrhosis in multivariable analyses. Among individuals with elevated APRI measurements pre- and 12–24 months post-ART initiation, 53 of 57 (93.0%) of HIV-monoinfected and 4 of 5 (80.0%) of HIV/HBV-coinfected had a regression to APRI < 1.5.
Conclusions. Hepatic fibrosis and cirrhosis were common in our cohort, especially among HIV/HBV-coinfected individuals. The APRI improved in most patients. Pre-ART HBsAg screening and early onset of tenofovir-based ART for HIV/HBV-coinfection should be prioritized in sub-Saharan Africa.
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Details
1 Department of Internal Medicine and Infectious Diseases, University Hospital Son Espases, Palma de Mallorca, Spain
2 Swiss Tropical and Public Health Institute of Basel; University of Basel
3 Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
4 Ifakara Health Institute, Ifakara Branch, United Republic of Tanzania
5 University of Basel; Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University Basel
6 Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Infectious Diseases, University Hospital Dakar, Senegal
7 Swiss Tropical and Public Health Institute of Basel; University of Basel; Ifakara Health Institute, Ifakara Branch, United Republic of Tanzania; ISGlobal, Centro de Investigación en Salud Internacional de Barcelona, Hospital Clínic-Universitat de Barcelona, Spain