Prevalence of Liver-fibrosis Using FIB-4 in HIV-patients on Anti-retroviral Therapy in Nigeria and CD4 and TNF as Predictors

Abstract

Introduction: Liver disease remains a severe complication in HIV patients despite advances in treatment with anti-retroviral drugs. The aim of this study was to analyze and report the prevalence and predictors of liver fibrosis in Nigerian HIV-infected adults on antiretroviral therapy and whether levels of TNF-α and CD4 count are associated with liver fibrosis as measured by FIB-4, we also try to explore the level of liver enzymes dysfunction using liver enzyme biomarkers, Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP) and categorizing participants using gender (male, female) and age to ascertain if gender and age will be associated with liver fibrosis in Nigerian HIV-infected patients) on Anti-retroviral (ARV) drugs in university of port Harcourt teaching hospital. Materials and Methods: A hospital-based study was conducted with a sample of 210 patients who were tested using randomized selection. Data on patients’ age and gender were collected, and blood samples were obtained for CD4, TNF, and LFT profiles. Extent of liver fibrosis was determined using the FIB-4, a non-invasive measuring index, to determine the presence and extent of fibrosis by categorizing as follows: FIB-4 value >3.25 as a proxy for advanced or severe  fibrosis, FIB-4 value between 1.45 and 3.25 in which fibrosis status is considered as significant fibrosis; FIB-4 value<1.45 considered as no fibrosis or absence of significant fibrosis, FIB-4=[age×AST (IU/liter)/platelet count (109/liter)×ALT (IU/liter)1/2]. Results: The prevalence of liver fibrosis reported was 21% was a slight male dominance in the prevalence ratio. Liver fibrosis correlated negatively with lower CD4 counts and elevated liver function biomarkers and TNF-alpha. Conclusion: The prevalence of liver fibrosis is high from this study. Increasing in age with elevated liver function biomarkers, TNF-alpha and reduced CD4 counts can be considered as predictors for liver fibrosis. Males are more likely to be affected than females.