High Prevalence of Liver Fibrosis Associated with HIV Infection: A Study in Rural Rakai,Uganda

Abstract

Background

Liver disease is a leading cause of mortality among HIV-infected persons in the United States and Europe. However, data regarding the effects of HIV and antiretroviral therapy (ART) on liver disease in Africa are sparse.

Methods

A total of 500 HIV-infected participants in an HIV care programme in rural Rakai, Uganda were frequency-matched by age, gender and site to 500 HIV-uninfected participants in a population cohort. All participants underwent transient elastography (FibroScan^®) to quantify liver stiffness measurements (LSM) and identify participants with significant liver fibrosis, defined as LSM≥9.3 kPa (≍ Metavir F≥2). Risk factors for liver fibrosis were identified by estimating adjusted prevalence risk ratios (adjPRR) and 95% CI using modified Poisson multivariate regression.

Results

The prevalence of hepatitis B coinfection in the study population was 5%. The prevalence of significant fibrosis was 17% among HIV-infected and 11% in HIV-uninfected participants (P=0.008). HIV infection was associated with a 50% increase in liver fibrosis (adjPRR 1.5, 95% CI 1.1–2.1; P=0.010). Fibrosis was also associated with male gender (adjPRR 1.4, 95% CI 1.0–1.9; P=0.045), herbal medicine use (adjPRR 2.0, 95% CI 1.2– 3.3; P=0.005), heavy alcohol consumption (adjPRR 2.3, 95% CI 1.3–3.9; P=0.005), occupational fishing (adjPRR 2.5, 95% CI 1.2–5.3; P=0.019) and chronic HBV infection (adjPRR 1.7, 95% CI 1.0–3.1; P=0.058). Among HIV-infected participants, ART reduced fibrosis risk (adjPRR 0.6, 95% CI 0.4–1.0; P=0.030).

Conclusions

The burden of liver fibrosis among HIV-infected rural Ugandans is high. These data suggest that liver disease may represent a significant cause of HIV-related morbidity and mortality in Africa.

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