Original Research

Comparison of non-invasive methods of assessing liver fibrosis in combination ART-experienced Zimbabweans

Brenda Nherera, Kudakwashe Mhandire, Tinashe K. Nyazika, Alfred Makura, Cuthbert Musarurwa, Prichard T. Mapondera, Babill Stray-Pedersen, Hilda T. Matarira
Southern African Journal of HIV Medicine | Vol 20, No 1 | a844 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.844 | © 2019 Brenda Nherera, Kudakwashe Mhandire, Tinashe Kenny Nyazika, Alfred Makura, Cuthbert Musarurwa, Prichard Tawanda Mapondera, Babill Stray-Pedersen, Hilda Tendisa Matarira | This work is licensed under CC Attribution 4.0
Submitted: 28 February 2018 | Published: 11 April 2019

About the author(s)

Brenda Nherera, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; and, Letten Foundation Research House, Harare, Zimbabwe
Kudakwashe Mhandire, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; and, Letten Foundation Research House, Harare, Zimbabwe
Tinashe K. Nyazika, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; and, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
Alfred Makura, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
Cuthbert Musarurwa, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
Prichard T. Mapondera, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; and, Division of Community Health, Stellenbosch University, Cape Town, South Africa
Babill Stray-Pedersen, Letten Foundation Research House, Harare, Zimbabwe; and Division of Women and Children, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Hilda T. Matarira, Department of Chemical Pathology, Faculty of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe


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Abstract

Background: The prevalence of morbidity and mortality associated with liver disease among HIV-infected individuals on combination antiretroviral therapy (ART) is high. Early screening of liver disease is essential, as it provides an opportunity for successful treatment. Hence, there is a need for reliable, inexpensive and non-invasive early markers of hepatic damage.

Objectives: Non-invasive algorithms are available for assessing the extent of liver fibrosis as markers of ongoing inflammatory damage. This study compared the use of the FibroTest, Fibrosis-4 (FIB-4) index, APRI test and AST:ALT ratio in assessing liver fibrosis in combination ART-experienced individuals.

Methods: In a comparative cross-sectional study, 79 participants between the ages of 8 and 62 years were recruited. The performance of each fibrosis algorithm was determined using established cut-off scores for clinically significant liver fibrosis.

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 biomarkers, A-2M concentration (p < 0.001) and AST activity (p = 0.003) remained significantly elevated in participants with fibrosis than those without as defined by FibroTest and APRI test, respectively, after adjustments for multiple comparisons.

Conclusion: Our data demonstrate a high prevalence of asymptomatic liver fibrosis among combination ART-experienced individuals in Zimbabwe, and this warrants adequate 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 biomarkers for detection of asymptomatic fibrosis.

 


Keywords

Liver fibrosis; Non-invasive methods; Biomarkers; Combination anti-retroviral therapy; Zimbabwe

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