Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia.
- Vinikoor MJ Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Sinkala E Department of Medicine, University of Zambia, Lusaka, Zambia.
- Mweemba A Department of Medicine, University of Zambia, Lusaka, Zambia.
- Zanolini A Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Mulenga L Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
- Sikazwe I Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
- Fried MW Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Eron JJ Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Wandeler G Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Chi BH Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
- 2015-01-13
Published in:
- Liver international : official journal of the International Association for the Study of the Liver. - 2015
AST-to-platelet ratio index
Africa
FIB-4
HIV/AIDS
hepatitis B virus
liver disease
Adult
Age Factors
Anti-HIV Agents
Aspartate Aminotransferases
Biomarkers
Cause of Death
Chemical and Drug Induced Liver Injury
Clinical Enzyme Tests
Female
HIV Infections
Humans
Kaplan-Meier Estimate
Liver Cirrhosis
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Platelet Count
Predictive Value of Tests
Prevalence
Proportional Hazards Models
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Zambia
English
BACKGROUND & AIMS
We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia.
METHODS
Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunological status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART.
RESULTS
Among 20 308 adults in the analysis cohort, 1027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4(+) count <200 cells/mm(3) , and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71-10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21-1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31-1.89) were associated with increased all-cause mortality.
CONCLUSION
Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings.
We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia.
METHODS
Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunological status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART.
RESULTS
Among 20 308 adults in the analysis cohort, 1027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4(+) count <200 cells/mm(3) , and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71-10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21-1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31-1.89) were associated with increased all-cause mortality.
CONCLUSION
Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1111/liv.12780
- PMID 25581487
- Persistent URL
- https://folia.unifr.ch/global/documents/60315
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