Vinikoor Michael J, Sinkala Edford, Chilengi Roma, Mulenga Lloyd B, Chi Benjamin H, Zyambo Zude, Hoffmann Christopher J, Saag Michael S, Davies Mary-Ann, Egger Matthias, Wandeler Gilles
Department of Medicine, University of Alabama at Birmingham.
Centre for Infectious Disease Research in Zambia.
Clin Infect Dis. 2017 May 15;64(10):1343-1349. doi: 10.1093/cid/cix122.
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.
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.
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).
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.
NCT02060162.
我们基于瞬时弹性成像（TE），对赞比亚接受抗逆转录病毒治疗（ART）的合并或未合并乙型肝炎病毒（HBV）感染的人类免疫缺陷病毒（HIV）感染者的肝纤维化变化进行了研究。
将患者开始接受ART时的肝脏硬度测量值（LSM；千帕斯卡[kPa]）分为无或轻度纤维化（相当于梅塔维分级F0 - F1）、显著纤维化（F2 - F3）和肝硬化（F4）。在ART治疗1年后重复进行TE检查。根据HBV合并感染状态（基线时乙肝表面抗原阳性）进行分层，我们描述了LSM的变化以及纤维化类别增加/减少的比例。使用多变量逻辑回归，我们评估了ART治疗1年后显著纤维化/肝硬化的相关因素。
在分析 的463例患者中（61例合并HBV感染），中位年龄为35岁，53.7%为女性，中位基线CD4 + 细胞计数为240个/立方毫米。几乎所有（97.6%）患者接受了含替诺福韦酯的ART治疗，这与国家推荐的一线治疗方案一致。LSM的中位变化为 - 0.70 kPa（95%置信区间， - 3.0至 + 1.7），合并和未合并HBV感染的情况相似。显著纤维化/肝硬化的发生率从14.0%降至6.7%（P < .001）。年龄增加、男性以及HBV合并感染是ART治疗1年后显著纤维化/肝硬化的预测因素（均P < .05）。
开始ART治疗后，无论HBV状态如何，赞比亚合并肝硬度升高提示显著纤维化/肝硬化的HIV感染成年患者的比例均有所下降。这表明HIV感染在肝脏炎症中起作用。合并HBV感染的患者在ART治疗1年后更有可能出现显著纤维化/肝硬化。
NCT02060162。
