Abstract
Introduction: Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub-Saharan Africa. Methods: The study was undertaken in three HIV referral clinics in Côte d’Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non-invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase-to-platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)-C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti-hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis. Results: A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36–50). Their median CD4 count was 393 cells/mm3 (IQR: 234–563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8–6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT-C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2–14.0), (Ref. AUDIT-C <4) and HBV infection (OR = 2.9, CI: 1.2–7.2). Of the 74 patients positively screened for HBV, 50.0% were on a tenofovir-based ART regimen. Overall, 10% of HIV/HBV coinfected patients were detected with a positive HDV antibody with a higher prevalence in patients with a significant liver fibrosis (43.0%) compared to others (6.3%) (p = 0.01). Conclusions: Considering the WHO recommendations to screen for HBV infection and treat co-infected patients with tenofovir-based ART, screening of alcohol use and brief interventions to prevent alcohol abuse should be implemented in West Africa, especially in HBV/HIV co-infected patients.
Highlights
Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries
Of the 856 participants solicited, 20 (2.4%) refused to participate. Among those who agreed to be screened for liver fibrosis, 29 (3.5%) were excluded from the present analysis for the following reasons: unreliable liver stiffness measure (LSM) (n = 20), indeterminate/unknown hepatitis B virus (HBV), hepatitis C virus (HCV) or HIV status (n = 4) and age
A total of 43 patients presented an aminotransferase-to-platelet ratio index (APRI) score ≥0.5 associated with a LSM ≥7.1 kPa providing an overall prevalence of significant fibrosis of 5.3%
Summary
Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. Liver diseases represent one of the leading causes of mortality in people living with HIV (PLWHIV) in industrialized countries [1,2]. Of these liver-related deaths, over 60% are attributable to hepatitis C virus (HCV) [3]. Chronic infection with hepatitis B virus (HBV) represents the main etiologic factor of liver-related mortality on this continent and is endemic especially in West Africa [5]. A better documentation of the burden of liver fibrosis and associated factors is needed
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