Increased Inflammation and Liver Disease in HIV/HBV-coinfected Individuals.

OBJECTIVE HIV and HBV co-infection can accelerate morbidity and mortality, especially in sub-Saharan Africa where both infections are common. While inflammation contributes to disease progression, more information is needed to better understand the pathology. This study compared markers of cirrhosis and inflammation in HIV/HBV coinfected individuals compared to monoinfected and uninfected patients. SETTING The HIV/HBV coinfected participants from the Ugandan arm of the prospective African Cohort Study (AFRICOS) were selected for evaluation and matched by age and sex with HIV-monoinfected, HBV-monoinfected, and uninfected controls. METHODS Plasma samples were used to quantify markers of immune activation and inflammation. The FIB-4 score was used to estimate liver fibrosis. Demographic and laboratory characteristics were compared across the groups. RESULTS Together, 31 HIV/HBV-coinfected participants were identified and compared to 62 HIV-monoinfected, 7 HBV-monoinfected, and 62 uninfected controls. The HIV/HBV-coinfected group had generally higher levels of inflammation. Most notably, MMP-2, MMP-9, and FGF-19 levels were dysregulated among the HIV/HBV-coinfected individuals. Furthermore, the FIB-4 score was higher in the HIV/HBV-coinfected group compared to the HIV-monoinfected group and revealed that 11% of HIV/HBV-coinfected individuals had evidence of undiagnosed advanced liver disease. CONCLUSIONS Differences in levels of inflammation exist between individuals with HIV/HBV coinfection compared with monoinfected, and uninfected controls. A distinct signature of inflammation was associated with HIV/HBV coinfection which could reflect the mechanism of liver fibrosis and increased risk for disease progression. Finally, there may be an underappreciated amount of undiagnosed advanced liver disease in sub-Saharan Africa.