Liver Disease in HIV/HBV Co-Infected Nigerians
Jos University Teaching Hospital (JUTH)
Dr. Rob Murphy
Approximately 2-4 million of the 33 million people living with HIV worldwide are co-infected with chronic Hepatitis B (HBV)1. In Nigeria and other parts of sub-Saharan Africa, where HBV is endemic, prevalence rates of HBV among HIV infected individuals range from 6-20%2, 3, 4. HIV and HBV have an uneasy co-existence. In developed countries, patients with HIV/HBV co-infection have been shown to have higher rates of liver-related complications than patients with HBV and HIV mono-infection5, 6 and liver disease secondary to viral hepatitis is now the leading cause of morbidity and mortality among HIV-infected individuals7, 8.
This study, entitled “An Assessment of Liver Disease in HIV/HBV Co-Infected Nigerians,” is a National Institutes for Health Fogarty supplement and will be assessing the prevalence of liver fibrosis and cirrhosis among ART naïve, HIV-infected individuals with and without Hepatitis B co-infection who are enrolled in an HIV Care and Treatment Program in Jos University Teaching Hospital (JUTH) in Nigeria. Nigeria has a high prevalence of HIV and Hepatitis B and subsequent liver disease, making this a vital area of study. The study will be the first of its kind to use the Fibroscan® technique to assess the degree of liver damage. The Fibroscan® uses pulse-echo ultrasound to follow propagation of an elastic shear wave through the liver tissue, and measures liver stiffness in a volume of liver that is much greater than that obtained from liver biopsy. The technique, performed much like an ultrasound is easily learned, quick to perform, and acceptable to patients. Fibroscan® has shown excellent diagnostic accuracy when compared to liver biopsy for hepatic fibrosis and cirrhosis and has been proposed as an alternative to liver biopsy making it a highly attractive for resource-limited settings.
1 Report UG. http://data.unaids.org/pub/Report/2009/jc1736_2008_ annual_report_en.pdf (12 October 2009, date last accessed
2 Lai CL, Ratziu V, Yuen MF, et al. Viral hepatitis B. Lancet 2003;362:2089-94.
3 Harania RS, Karuru J, Nelson M, et al. HIV, hepatitis B and hepatitis C co-infection in Kenya. AIDS 2008; 22:1221-2.
4 Hoffman CJ Charalambous S, Martin DJ, et al. Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program. Clin Infect Dis. 2008; 47:1479-85.
5 Puoti M, Torti C, Bruno R, et al. Natural history of chronic hepatitis B in co-infected patients. J Hepatol 2006; 44:S65-70.
6 Sulkowski MS, Thomas DL, Chaisson RE, et al. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 2000; 283:74-80
7 Bica I, McGovern B, Dhar R, et al. Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis 2001; 32:492-7.
8 Palella Jr FJ, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006; 43:27-34.
This page last updated Sep 1, 2011