Page 220 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

Comparison of non-invasive methods

of assessing liver fibrosis in combination

ART-experienced Zimbabweans

Authors: Background: The prevalence of morbidity and mortality associated with liver disease among
Brenda Nherera HIV-infected individuals on combination antiretroviral therapy (ART) is high. Early screening
1,2
Kudakwashe Mhandire 1,2
Tinashe K. Nyazika of liver disease is essential, as it provides an opportunity for successful treatment. Hence, there
1,3
Alfred Makura 1 is a need for reliable, inexpensive and non-invasive early markers of hepatic damage.
Cuthbert Musarurwa 1
1,4
Prichard T. Mapondera Objectives: Non-invasive algorithms are available for assessing the extent of liver fibrosis as
Babill Stray-Pedersen markers of ongoing inflammatory damage. This study compared the use of the FibroTest,
2,5
Hilda T. Matarira 1 Fibrosis-4 (FIB-4) index, APRI test and AST:ALT ratio in assessing liver fibrosis in combination
ART-experienced individuals.
Affiliations:
1 Department of Chemical Methods: In a comparative cross-sectional study, 79 participants between the ages of 8 and
Pathology, Faculty of
Medicine, College of Health 62 years were recruited. The performance of each fibrosis algorithm was determined using
Sciences, University of established cut-off scores for clinically significant liver fibrosis.
Zimbabwe, Harare,
Zimbabwe Results: The prevalence of liver fibrosis as determined by the FibroTest, FIB-4 index, APRI test
and AST: ALT ratio were 19.0%, 21.5%, 12.7% and 79.7%, respectively. For individual
2 Letten Foundation Research biomarkers, A-2M concentration ( p < 0.001) and AST activity ( p = 0.003) remained significantly
House, Harare, Zimbabwe elevated in participants with fibrosis than those without as defined by FibroTest and APRI test,
respectively, after adjustments for multiple comparisons.
3 Malawi-Liverpool-Wellcome
Trust Clinical Research Conclusion: Our data demonstrate a high prevalence of asymptomatic liver fibrosis among
Programme, University of combination ART-experienced individuals in Zimbabwe, and this warrants adequate
Malawi College of Medicine,
Blantyre, Malawi monitoring of liver fibrosis in individuals on ART. Discordance of fibrosis results among the
algorithms and individual biomarkers and calls for further work in identifying optimal
4 Division of Community biomarkers for detection of asymptomatic fibrosis.
Health, Stellenbosch
University, Cape Town, Keywords: Liver fibrosis; Non-invasive methods; Biomarkers; Combination anti-retroviral
South Africa therapy; Zimbabwe.

5 Division of Women and
Children, Institute of Clinical Introduction
Medicine, University of Oslo,
Oslo, Norway Sub-Saharan Africa faces a substantial burden of liver disease, with mortality owing to cirrhosis
1
Corresponding author: doubling over the past three decades. Globally, liver disease accounts for 14% – 18% of deaths
Brenda Nherera, among the human immunodeficiency virus (HIV)-infected population and approximately 50% of
[email protected] deaths among hospitalised HIV-infected individuals. Morbidity and mortality associated with
2,3
liver disease in sub-Saharan Africa remains higher among the HIV-infected population than in the
Dates:
Received: 28 Feb. 2018 uninfected population despite increasing access to combination antiretroviral therapy (ART). 3,4,5
Accepted: 05 Feb. 2019 Longevity related to combination antiretroviral therapy among the HIV-infected population
Published: 11 Apr. 2019 allows for the development of non-acquired immune deficiency syndrome (AIDS) events, such as
nephrotoxicity, cardiovascular disease and liver complications, associated with chronic ART
exposure, HIV infection itself and other comorbidities such as chronic hepatitis B virus (HBV)
infection to a greater extent and hepatitis C virus (HCV) infection to a lesser axtent.
5,6
Whilst the liver is a regenerative organ that is capable of complete resolution with early detection
6,7
and treatment, patients with established cirrhosis or hepatocellular carcinoma (HCC) usually
1
present late. Thus, timely diagnosis is critical for successful treatment, especially among HIV-
Read online: infected individuals, hence the need for simple, accessible, accurate, point-of-care diagnostic
Read online:
Scan this QR technologies. 1,6,7 In resource-limited settings, early detection of liver fibrosis is limited by the
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mobile device How to cite this article: Nherera B, Mhandire K, Nyazika TK, et al. Comparison of non-invasive methods of assessing liver fibrosis in
to read online. combination ART-experienced Zimbabweans. S Afr J HIV Med. 2019;20(1), a844. https://doi.org/10.4102/sajhivmed.v20i1.844
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Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 213 Open Access