Comparison of on-treatment Noninvasive Markers of Liver Fibrosis Among Patients with HBV and HBV/HIV Coinfection in Ethiopia

Abstract Background: Noninvasive markers of liver fibrosis have gained central importance in the assessment of patients with liver diseases. Among patients with Hepatitis B and HIV coinfection, the role of these noninvasive serum markers has not been well studied in the Ethiopian setup. Methodology: A hospital-based cross-sectional study was conducted at Tikur Anbessa Hospital ART clinic. Patients with HIV and HBV coinfection were recruited from the clinic, and a second comparison group with HBV mono-infection was recruited from the liver clinic. All patients were on tenofovir-based treatment of hepatitis B. Baseline demographic and laboratory values comparison between the two groups were conducted. For APRI, a cutoff of 0.5 and 1.5 was used to assess fibrosis; and for FIB4, cutoffs of 1.45 and 3.25 were used as the lower and higher cutoff, respectively. Result: A total of 74 patients were included, of which 24 patients were with HBV/HIV coinfection and 50 were with HBV mono-infection. The median age of participants was 37, and the majority were from Addis Ababa. Prevalence of diabetes and alcohol use was comparable in both groups. The median platelet count among patients with coinfection was 220,000 ( IQR 159000 - 277000), while among the monoinfected patients, it was 166000 ( 87750-227500). The APRI score among the coinfected patients was 0.4 ( 0.23 – 0.59) while it was 0.57 (0.4-1.4) ( p= 0.01). The FIB4 was 1.1 ( 0.69 – 2.03 ) among coinfected patients, while it was 1.7 (1 - 2.9) among monoinfected patients ( p=0.01). Using a lower and higher APRI and FIB4 cutoffs, both groups had a statistically nonsignificant difference. However, the platelet count using a cutoff of 1500000 was significantly lower among patients with HBV mono-infection. Conclusion; Our data indicate that patients with HIV/HBV coinfection on treatment had comparable noninvasive liver fibrosis marker profiles compared to patients with HBV mono-infection on therapy. On the majority of the parameters, there was a trend towards a better profile among patients with coinfection, which might be explained by early initiation of tenofovir therapy as part of HIV treatment.