Prevalence and Outcomes of Hepatitis B Coinfection and Associated Liver Disease Among Antiretroviral Therapy-Naive Individuals in a Rural Tanzanian Human Immunodeficiency Virus Cohort

被引:20
作者
Ramirez-Mena, Adria [1 ]
Glass, Tracy R. [2 ,3 ]
Winter, Annja [4 ]
Kimera, Namvua [5 ]
Ntamatungiro, Alex [5 ]
Hatz, Christoph [2 ,3 ]
Tanner, Marcel [2 ,3 ]
Battegay, Manuel [3 ,6 ,7 ]
Furrer, Hansjakob [4 ]
Wandeler, Gilles [4 ,8 ,9 ]
Letang, Emilio [2 ,3 ,5 ,10 ]
机构
[1] Univ Hosp Son Espases, Dept Internal Med & Infect Dis, Carretera Valldemossa, Palma De Mallorca 07210 79, Spain
[2] Swiss Trop & Publ Hlth Inst Basel, Basel, Switzerland
[3] Univ Basel, CH-4003 Basel, Switzerland
[4] Univ Bern, Univ Hosp Bern, Dept Infect Dis, CH-3012 Bern, Switzerland
[5] Ifakara Hlth Inst, Ifakara Branch, Dar Es Salaam, Tanzania
[6] Univ Basel, Univ Hosp, Div Infect Dis, CH-4003 Basel, Switzerland
[7] Univ Basel, Univ Hosp, Hosp Epidemiol, CH-4003 Basel, Switzerland
[8] Univ Bern, Inst Social & Prevent Med, CH-3012 Bern, Switzerland
[9] Univ Hosp Dakar, Dept Infect Dis, Dakar, Senegal
[10] Univ Barcelona, Hosp Clin, Ctr Invest Salud Internac Barcelona, ISGlobal, E-08007 Barcelona, Spain
来源
OPEN FORUM INFECTIOUS DISEASES | 2016年 / 3卷 / 03期
基金
瑞士国家科学基金会;
关键词
APRI; hepatitis B virus; HIV; liver fibrosis; Tanzania; PLATELET RATIO INDEX; TENOFOVIR DISOPROXIL FUMARATE; HIV-INFECTED ADULTS; TRANSIENT ELASTOGRAPHY; ASPARTATE-AMINOTRANSFERASE; HEPATOCELLULAR-CARCINOMA; FIBROSIS; METAANALYSIS; LAMIVUDINE; MORTALITY;
D O I
10.1093/ofid/ofw162
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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/mu L 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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页数:8
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