Association between hepatitis B co‐infection and elevated liver stiffness among <scp>HIV</scp>‐infected adults in Lusaka, Zambia

Abstract Objective To describe liver disease epidemiology among HIV ‐infected individuals in Zambia. Methods We recruited HIV ‐infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements ( LSM ) according to established thresholds (>7.0 kP a for significant fibrosis and >11.0 kP a for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B ( HBV ) and C virus co‐infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness. Results Among 798 HIV ‐infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co‐infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co‐infection (<1%) was rare. According to LSM , 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co‐infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kP a (all P < 0.05). HBV co‐infection was the only independent risk factor for LSM >11.0 kP a. Among HIV – HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity. Conclusions HBV co‐infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.