Wekesa Clara, Kirk Gregory D, Aizire Jim, Benson Eve-Marie, Karabarinde Alex, Parkes-Ratanshi Rosalind, Ocama Ponsiano
MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research, Entebbe, Uganda.
HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda.
Open Forum Infect Dis. 2020 Oct 13;7(11):ofaa483. doi: 10.1093/ofid/ofaa483. eCollection 2020 Nov.
Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda.
This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site.
Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; = .017). History of tobacco use (urban = .022; rural = .035) and serologic evidence of hepatitis C infection (HCV; urban = .028; rural = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban = .002; rural = .028) and increasing age (urban = .008; rural = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic ( = .003), and detectable HIV viral load ( = .002) for men in the urban clinic.
Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.
肝纤维化在HIV感染患者中很常见。危险因素因地区而异。了解这种差异可能有助于制定预防策略。我们比较了乌干达接受治疗的HIV感染患者中肝纤维化的患病率及其相关因素。
这是一项横断面研究，涉及2030名在乌干达城乡接受治疗的HIV感染患者。肝纤维化定义为肝脏硬度测量值（LSM）>7.1千帕。使用按性别和地点分层的逻辑回归评估并比较肝纤维化的比例及其相关因素。
农村诊所参与者的肝纤维化患病率更高（15%对11%；P = 0.017）。在所有男性中，吸烟史（城市P = 0.022；农村P = 0.035）和丙型肝炎病毒（HCV）感染的血清学证据（城市P = 0.028；农村P = 0.03）与肝纤维化相关。在所有女性中，肝转氨酶升高（城市P = 0.002；农村P = 0.028）和年龄增长（城市P = 0.008；农村P = 0.052）是危险因素。女性吸烟仅在农村诊所的患者中是危险因素（P = 0.003），而在城市诊所男性中，可检测到的HIV病毒载量是危险因素（P = 0.002）。
肝纤维化在乌干达的HIV感染者中很普遍。抑制HIV病毒和避免吸烟可能是预防肝纤维化和癌症风险的策略。
