Abstract
Background: The prevalence of morbidity and mortality associated with liver disease among HIV-infected individuals on combination antiretroviral therapy (ART) is high. Early screening of liver disease is essential, as it provides an opportunity for successful treatment. Hence, there is a need for reliable, inexpensive and non-invasive early markers of hepatic damage.Objectives: Non-invasive algorithms are available for assessing the extent of liver fibrosis as markers of ongoing inflammatory damage. This study compared the use of the FibroTest, Fibrosis-4 (FIB-4) index, APRI test and AST:ALT ratio in assessing liver fibrosis in combination ART-experienced individuals.Methods: In a comparative cross-sectional study, 79 participants between the ages of 8 and 62 years were recruited. The performance of each fibrosis algorithm was determined using established cut-off scores for clinically significant liver fibrosis.Results: The prevalence of liver fibrosis as determined by the FibroTest, FIB-4 index, APRI test and AST: ALT ratio were 19.0%, 21.5%, 12.7% and 79.7%, respectively. For individual biomarkers, A-2M concentration (p < 0.001) and AST activity (p = 0.003) remained significantly elevated in participants with fibrosis than those without as defined by FibroTest and APRI test, respectively, after adjustments for multiple comparisons.Conclusion: Our data demonstrate a high prevalence of asymptomatic liver fibrosis among combination ART-experienced individuals in Zimbabwe, and this warrants adequate monitoring of liver fibrosis in individuals on ART. Discordance of fibrosis results among the algorithms and individual biomarkers and calls for further work in identifying optimal biomarkers for detection of asymptomatic fibrosis.Keywords: Liver fibrosis; Non-invasive methods; Biomarkers; Combination anti-retroviral therapy; Zimbabwe.
Highlights
Sub-Saharan Africa faces a substantial burden of liver disease, with mortality owing to cirrhosis doubling over the past three decades.[1]
Longevity related to combination antiretroviral therapy among the human immunodeficiency virus (HIV)-infected population allows for the development of non-acquired immune deficiency syndrome (AIDS) events, such as nephrotoxicity, cardiovascular disease and liver complications, associated with chronic ART exposure, HIV infection itself and other comorbidities such as chronic hepatitis B virus (HBV) infection to a greater extent and hepatitis C virus (HCV) infection to a lesser axtent.[5,6]
One aliquot of serum was immediately analysed for ALT, AST, g-glutamyl transferase (GGT), total bilirubin (TBil) and HBV, whilst another aliquot was immediately frozen and kept at −80 °C for six weeks before measurement of haptoglobin, apolipoprotein A-1 (Apo A-1) and alpha-2 macroglobulin (A-2M) concentrations
Summary
Sub-Saharan Africa faces a substantial burden of liver disease, with mortality owing to cirrhosis doubling over the past three decades.[1]. Whilst the liver is a regenerative organ that is capable of complete resolution with early detection and treatment,[6,7] patients with established cirrhosis or hepatocellular carcinoma (HCC) usually present late.[1] timely diagnosis is critical for successful treatment, especially among HIVinfected individuals, the need for simple, accessible, accurate, point-of-care diagnostic technologies.[1,6,7] In resource-limited settings, early detection of liver fibrosis is limited by the http://www.sajhivmed.org.za. The prevalence of morbidity and mortality associated with liver disease among HIV-infected individuals on combination antiretroviral therapy (ART) is high. Screening of liver disease is essential, as it provides an opportunity for successful treatment. There is a need for reliable, inexpensive and non-invasive early markers of hepatic damage
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