Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

Jennifer L. Grant*, Patricia Agaba, Placid Ugoagwu, Auwal Muazu, Jonathan Okpokwu, Samuel Akpa, Stephen MacHenry, Godwin Imade, Oche Agbaji, Chloe L. Thio, Robert Leo Murphy, Claudia A Hawkins

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- A nd HIV/HBV-infected individuals. Objectives: To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- A nd HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods: We included ART-naive HIV- A nd HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cutoffs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We usedmultivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results: A total of 106 HIV- A nd 71 HIV/HBV-infected patients [70.5% female and median age"34 years (IQR=29-42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV-versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P,0.01); LSM scores at year 3 were not significantly different between HIV- A nd HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4! T cells≥200 (versus ,200) cells/mm3 and lower BMIs weremore likely to experience LSM stage decline. Conclusions: HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

Original languageEnglish (US)
Pages (from-to)2003-2008
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Volume74
Issue number7
DOIs
StatePublished - Jul 1 2019

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HIV
Liver
Elasticity Imaging Techniques
Fibrosis
Liver Diseases
Africa South of the Sahara
Nigeria
Coinfection
Teaching Hospitals
Liver Cirrhosis
Longitudinal Studies
Prospective Studies

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Grant, Jennifer L. ; Agaba, Patricia ; Ugoagwu, Placid ; Muazu, Auwal ; Okpokwu, Jonathan ; Akpa, Samuel ; MacHenry, Stephen ; Imade, Godwin ; Agbaji, Oche ; Thio, Chloe L. ; Murphy, Robert Leo ; Hawkins, Claudia A. / Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV. In: Journal of Antimicrobial Chemotherapy. 2019 ; Vol. 74, No. 7. pp. 2003-2008.
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title = "Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV",
abstract = "Background: There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- A nd HIV/HBV-infected individuals. Objectives: To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- A nd HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods: We included ART-naive HIV- A nd HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cutoffs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We usedmultivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results: A total of 106 HIV- A nd 71 HIV/HBV-infected patients [70.5{\%} female and median age{"}34 years (IQR=29-42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV-versus HIV-infected patients; 41{\%} of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17{\%} of HIV-infected patients (P,0.01); LSM scores at year 3 were not significantly different between HIV- A nd HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4! T cells≥200 (versus ,200) cells/mm3 and lower BMIs weremore likely to experience LSM stage decline. Conclusions: HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.",
author = "Grant, {Jennifer L.} and Patricia Agaba and Placid Ugoagwu and Auwal Muazu and Jonathan Okpokwu and Samuel Akpa and Stephen MacHenry and Godwin Imade and Oche Agbaji and Thio, {Chloe L.} and Murphy, {Robert Leo} and Hawkins, {Claudia A}",
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Grant, JL, Agaba, P, Ugoagwu, P, Muazu, A, Okpokwu, J, Akpa, S, MacHenry, S, Imade, G, Agbaji, O, Thio, CL, Murphy, RL & Hawkins, CA 2019, 'Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV', Journal of Antimicrobial Chemotherapy, vol. 74, no. 7, pp. 2003-2008. https://doi.org/10.1093/jac/dkz145

Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV. / Grant, Jennifer L.; Agaba, Patricia; Ugoagwu, Placid; Muazu, Auwal; Okpokwu, Jonathan; Akpa, Samuel; MacHenry, Stephen; Imade, Godwin; Agbaji, Oche; Thio, Chloe L.; Murphy, Robert Leo; Hawkins, Claudia A.

In: Journal of Antimicrobial Chemotherapy, Vol. 74, No. 7, 01.07.2019, p. 2003-2008.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

AU - Grant, Jennifer L.

AU - Agaba, Patricia

AU - Ugoagwu, Placid

AU - Muazu, Auwal

AU - Okpokwu, Jonathan

AU - Akpa, Samuel

AU - MacHenry, Stephen

AU - Imade, Godwin

AU - Agbaji, Oche

AU - Thio, Chloe L.

AU - Murphy, Robert Leo

AU - Hawkins, Claudia A

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- A nd HIV/HBV-infected individuals. Objectives: To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- A nd HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods: We included ART-naive HIV- A nd HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cutoffs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We usedmultivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results: A total of 106 HIV- A nd 71 HIV/HBV-infected patients [70.5% female and median age"34 years (IQR=29-42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV-versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P,0.01); LSM scores at year 3 were not significantly different between HIV- A nd HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4! T cells≥200 (versus ,200) cells/mm3 and lower BMIs weremore likely to experience LSM stage decline. Conclusions: HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

AB - Background: There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- A nd HIV/HBV-infected individuals. Objectives: To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- A nd HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods: We included ART-naive HIV- A nd HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cutoffs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We usedmultivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results: A total of 106 HIV- A nd 71 HIV/HBV-infected patients [70.5% female and median age"34 years (IQR=29-42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV-versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P,0.01); LSM scores at year 3 were not significantly different between HIV- A nd HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4! T cells≥200 (versus ,200) cells/mm3 and lower BMIs weremore likely to experience LSM stage decline. Conclusions: HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

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