Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia.

Academic Article


  • 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.
  • Published In


  • Africa, HIV/AIDS, hepatitis B virus, liver fibrosis, transient elastography., Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Benzoxazines, CD4 Lymphocyte Count, Cohort Studies, Coinfection, Elasticity Imaging Techniques, Emtricitabine, Female, HIV Infections, Hepatitis B, Hepatitis B Surface Antigens, Hepatitis B virus, Humans, Liver, Liver Cirrhosis, Logistic Models, Male, Prospective Studies, Viral Load, Zambia
  • Digital Object Identifier (doi)

    Author List

  • Vinikoor MJ; Sinkala E; Chilengi R; Mulenga LB; Chi BH; Zyambo Z; Hoffmann CJ; Saag MS; Davies M-A; Egger M
  • Start Page

  • 1343
  • End Page

  • 1349
  • Volume

  • 64
  • Issue

  • 10