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Advanced fibrosis found in one-third of patients with HIV/HBV coinfection

Researchers observed significant fibrosis in more than one-third of patients with hepatitis B and HIV coinfection undergoing long-term combination antiretroviral therapy with viral suppression, according to a study published in American Journal of Gastroenterology.

“HIV treatment guidelines recommend that all HIV-infected persons with active HBV infection ... undergo treatment of both infections with [combination ART] including tenofovir,” Richard K. Sterling, MD, MSc, FACG, from Virginia Commonwealth University, and colleagues wrote. “Our data provides novel and clinically important findings regarding the spectrum of liver disease in persons living with HIV/HBV coinfection.”

To assess the spectrum of liver disease in HIV/HBV coinfection among patients in North America, Sterling and colleagues analyzed the histologic data of 114 patients. The spectrum of disease was defined by the Ishak Histologic Activity Index (HAI) and advanced fibrosis.

The researchers observed significant fibrosis in 36.9%, advanced fibrosis in 23.7% and cirrhosis in 5%. Additionally, 29% of patients had steatosis higher than 5% and 10% of patients had NASH.

A history of diabetes (P = .002) and aspartate aminotransferase levels (P < .001) correlated significantly with HAI after adjusting for platelet count, CD4, and detectable HIV RNA and HBV DNA. Patients with a history of diabetes had an average 2.1 higher points on the HAI and each 10 IU/L increase in AST correlated with 0.5 points higher on the HAI compared with patients with no history of diabetes.

After multivariate analysis, alanine aminotransferase (P = .03) and platelet count (P = .02) correlated with advanced fibrosis. Each 10 IU/L increase in ALT correlated with a 19% increased risk for advanced fibrosis (OR = 1.19; 95% CI, 1.01-1.41). In contrast, each 20,000 mm³ increase in platelet counts correlated with a 19% lower risk for advanced fibrosis (OR = 0.81; 95% CI, 0.67-0.97).

“Additional analyses of this cohort are underway to better define histologic progression and/or regression associated with [combination ART] that includes tenofovir by paired liver biopsy to determine if factors other than HBV suppression, such as specific components of [combination ART], identify predictors of steatosis and to determine non-invasive assessments to predict which patients might need to undergo liver biopsy to identify significant fibrosis,” Sterling and colleagues wrote. “Until then, HBV-HIV patients require close monitoring for disease severity.” – by Talitha Bennett

Disclosure: Sterling reports financial connections with AbbVie, Baxter, Gilead, Merck, Pfizer and Roche. Please see the full study for the other authors’ relevant financial disclosures.