Hawkins Claudia, Christian Beatrice, Fabian Emanuel, Macha Irene, Gawile Cecilia, Mpangala Shida, Ulenga Nzovu, Thio Chloe L, Ammerman Lauren R, Mugusi Ferdinand, Fawzi Wafaie, Green Richard, Murphy Robert
*Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; †Management and Development for Health, Dar es Salaam, Tanzania; ‡Department of Medicine, Johns Hopkins University, Baltimore, MD; §Northwestern University Feinberg School of Medicine, Chicago, IL; ‖Department of Medicine, Muhumbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and ¶Departments of Nutrition, Epidemiology and Global Health and Population, Harvard T. H Chan School of Public Health, Boston, MA.
J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):298-302. doi: 10.1097/QAI.0000000000001491.
In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B virus (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV coinfection in Tanzania.
Using a cross-sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV monoinfected, HBV monoinfected, and HIV/HBV-coinfected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI >0.5 and FIB-4 >1.45) were examined.
Two hundred sixty-seven HIV-infected, 165 HBV-infected, and 63 HIV/HBV-coinfected patients were analyzed [44% men, median age 37 (interquartile range 14), body mass index 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, P < 0.001, R = 0.61). Overall median APRI scores were low {HIV/HBV [0.36 (interquartile range 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (P < 0.01)}. In multivariate analyses, HIV/HBV coinfection was associated with APRI >0.5 [HIV/HBV vs. HIV: odds ratio (OR) 3.78 (95% confidence interval: 1.91 to 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26 to 5.44)]. HIV RNA per 1 log10 copies/mL increase [OR 1.53 (95% confidence interval: 1.04 to 2.26)] and HBV DNA per 1 log10 copies/mL increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively.
HIV/HBV coinfection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV coinfection is warranted.
在撒哈拉以南非洲地区，慢性乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）相关肝病的负担尚不清楚。我们在坦桑尼亚的HIV、HBV及HIV/HBV合并感染患者中，使用天冬氨酸转氨酶与血小板比值指数（APRI）和FIB-4对肝病进行了特征分析。
采用横断面设计，我们比较了在坦桑尼亚达累斯萨拉姆由健康管理与发展组织（MDH）支持的HIV治疗诊所中，未经治疗的单纯HIV感染、单纯HBV感染以及HIV/HBV合并感染的成年患者肝纤维化的患病率。研究了与显著纤维化（APRI>0.5且FIB-4>1.45）相关的危险因素。
对267例HIV感染、165例HBV感染和63例HIV/HBV合并感染患者进行了分析[男性占44%，中位年龄37岁（四分位间距14），体重指数23（7）]。APRI和FIB-4高度相关（r = 0.78，P < 0.001，R = 0.61）。总体APRI中位数得分较低{HIV/HBV[0.36（四分位间距0.4）]，HIV[0.23（0.17）]，HBV[0.29（0.15）]（P < 0.01）}。在多变量分析中，HIV/HBV合并感染与APRI>0.5相关[HIV/HBV与HIV相比：比值比（OR）3.78（95%置信区间：1.91至7.50）]，[HIV/HBV与HBV相比：OR 2.61（1.26至5.44）]。在HIV感染患者中，HIV RNA每增加1 log10拷贝/mL[OR 1.53（95%置信区间：1.04至2.26）]，在HBV感染患者中，HBV DNA每增加1 log10拷贝/mL[OR 1.36（1.15，1.62）]分别与APRI>0.5独立相关。
HIV/HBV合并感染是显著纤维化的重要危险因素。循环中较高水平的HIV和HBV病毒可能在肝纤维化形成中起直接作用。对于HIV/HBV合并感染患者，有必要进行及时诊断和积极的肝病监测。
