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Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia.
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.
Afiliação
  • Vinikoor MJ; Department of Medicine, University of Alabama at Birmingham.
  • Sinkala E; Centre for Infectious Disease Research in Zambia.
  • Chilengi R; School of Medicine, University of Zambia, and.
  • Mulenga LB; School of Medicine, University of Zambia, and.
  • Chi BH; Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
  • Zyambo Z; Centre for Infectious Disease Research in Zambia.
  • Hoffmann CJ; School of Medicine, University of Zambia, and.
  • Saag MS; Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
  • Davies MA; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill.
  • Egger M; Centre for Infectious Disease Research in Zambia.
  • Wandeler G; Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Clin Infect Dis ; 64(10): 1343-1349, 2017 May 15.
Article em En | MEDLINE | ID: mdl-28158504
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. CLINICAL TRIALS REGISTRATION: NCT02060162.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Terapia Antirretroviral de Alta Atividade / Coinfecção / Hepatite B / Cirrose Hepática Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País como assunto: Africa Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Terapia Antirretroviral de Alta Atividade / Coinfecção / Hepatite B / Cirrose Hepática Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País como assunto: Africa Idioma: En Ano de publicação: 2017 Tipo de documento: Article