Alcohol use, viral hepatitis and liver fibrosis among HIV‐positive persons in West Africa: a cross‐sectional study

• Published in: Journal of the International AIDS Society 2017-02, Vol.20 (1), p.21424-n/a
• Main Authors: Jaquet, Antoine, Wandeler, Gilles, Nouaman, Marcellin, Ekouevi, Didier K, Tine, Judicaël, Patassi, Akouda, Coffie, Patrick A, Tanon, Aristophane, Seydi, Moussa, Attia, Alain, Dabis, François
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Addictive behaviors; Adult; Africa; AIDS; AIDS/HIV; alcohol; Alcohol abuse; Alcohol Drinking; Alcohol use; Alcohols; Analysis; Antibodies; Antiretroviral agents; CD4 Lymphocyte Count; Coinfection - epidemiology; Cote d'Ivoire - epidemiology; Cross-Sectional Studies; Dosage and administration; Drinking (Alcoholic beverages); Drug therapy; Female; Health aspects; Hepatitis; Hepatitis B; Hepatitis C; hepatitis D; Hepatitis, Viral, Human - complications; Hepatitis, Viral, Human - epidemiology; Hepatology; HIV; HIV Infections - complications; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Immune system; Infections; Laboratories; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; liver fibrosis; Male; Middle Aged; Mortality; Patients; Population; Prevalence; Questionnaires; Senegal - epidemiology; Serology; Studies; Systematic review; Tobacco; Togo - epidemiology; Viruses
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.20.1.21424

Introduction: Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub‐Saharan Africa. Methods: The study was undertaken in three HIV referral clinics in Côte d’Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non‐invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase‐to‐platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)‐C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti‐hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis. Results: A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36–50). Their median CD4 count was 393 cells/mm3 (IQR: 234–563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8–6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT‐C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2–14.0), (Ref. AUDIT‐C