Title

Prevalence of significant liver fibrosis in patients with HIV monoinfection compared to those with HIV-hepatitis b coinfection as assessed by shear wave elastography

Date of Award

2014

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

Department

Imaging and Diagnostic Radiology (East Africa)

Abstract

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients.

Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE).

Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at AKUH, N were consecutively recruited into the study. A total of 105 patients, 70 with HIV mono-infection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for presence of significant fibrosis the cut-off of which was 5.6 kPa. The prevalence of significant liver fibrosis was compared between the two groups. Assessment of APRI score (a non-invasive serum biomarker of liver fibrosis) in these patients was also done.

Results: The prevalence of advanced liver fibrosis was significantly higher (p <0.0001) in patients with HIV-HBV co-infection, 25.7%, compared to those with HIV mono-infection, 7.1%. APRI score was higher in patients with HIV-HBV co-infection than those with HIV mono-infection.

Discussion: The prevalence of significant liver fibrosis observed in the two proportions in the current study is comparable to those reported in other studies. HIV co-infection with HBV accelerates progression to significant liver fibrosis. Association of low CD 4 count with advanced fibrosis supports earlier starting of antiretroviral therapy to prevent rapid progression of liver disease in HIV positive patients. Higher APRI scores in the HIV-HBV co-infected group was as a result of higher AST levels.

Conclusion/recommendations: In view of the high prevalence of liver fibrosis in patients with HIV-HBV co-infection, regular monitoring of the disease progression is recommended. A study involving follow up of HIV-HBV co-infected patients to assess for effects of therapy is also recommended.

This document is available in the relevant AKU library

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