2221. Markers of Cirrhosis and Inflammation in HIV/HBV Co-infection in a Ugandan Cohort
Session: Poster Abstract Session: HIV and HBV
Saturday, October 7, 2017
Room: Poster Hall CD

Background: Co-infection with HIV and hepatitis B virus (HBV) is common, reaching 23% in Uganda, and can accelerate HBV disease progression. Inflammation contributes to the pathogenesis of both viruses. We compared serological biomarkers of inflammation and FIB-4 scores (to predict liver fibrosis) stratified by HIV and HBV status in a Ugandan cohort.

Methods: Subjects with HIV/HBV co-infection were matched up to 2:1 by age and gender with HIV-monoinfected, HBV-monoinfected, and uninfected controls from the Ugandan site of the African Cohort Study (AFRICOS). Demographic and laboratory characteristics, including inflammatory biomarkers, were compared between the groups. FIB-4 scores were stratified as <1.45, 1.45-3.25, and >3.25 for those unlikely to have advanced fibrosis, indeterminate, and likely to have advanced fibrosis, respectively (resp.), in the HIV/HBV and HIV groups, which had these data available.

Results: Within the Ugandan subset of AFRICOS, 31 HIV/HBV co-infected patients were available and compared to 62 HIV-monoinfected, 7 (all that were available) HBV-monoinfected, and 62 uninfected subjects. Median age was 37 (range 19-67) years and 78% were male. The HBV group, as compared to the HIV/HBV, HIV, and uninfected groups, had higher prevalence of hepatitis C antibody (29%, 6%, 2%, 3%, resp.; p = 0.04), fewer other active infections (0%, 48%, 52%, 26%, resp.; p = 0.002), fewer non-antiretroviral medications (median 0, 1, 2, 0, resp.; p < 0.001), and a smaller proportion on an antimicrobial (0%, 32%, 37%, 18%, resp.; p = 0.03). The HIV/HBV group had generally higher levels of inflammation overall and statistically had significantly higher levels of MMP-12 and lower levels of FGF-23 compared to the other groups (Figure 1). The HIV/HBV group had a lower proportion of subjects unlikely to have advanced fibrosis by FIB-4 (Figure 2; = 0.046).

Conclusion: Elevated MMP-12 in the HIV/HBV group suggests that elastin degradation may be a mechanism contributing to the accelerated progression of liver disease seen in co-infection. Prior literature demonstrated that FGF-23 is elevated in end-stage liver disease and predicts mortality, but we did not observe higher levels in HIV/HBV co-infection in this cohort with little advanced liver disease. Further studies are needed to characterize the inflammatory milieu and evaluate the impact of time and treatment of HIV/HBV.

Nathanial K. Copeland, MD1,2, Michael A. Eller, PhD3,4, Matthew Creegan, MS3,4, Allahna Esber, PhD3,4, Trevor A. Crowell, MD, PhD2,3,4, Leigh Anne Eller, PhD3,4, Michael Semwogerere, BSPH, DMSCH5, Hannah Kibuuka, MBChB, MMed, MPH5, Francis Kiweewa, MBChB, MMed, MPH5, Fatim Cham, PhD4,5, Kavitha Ganesan, MPH3,4, Christina S. Polyak, MD, MPH3,4 and Julie Ake, MD, MSc3, (1)Walter Reed National Military Medical Center, Bethesda, MD, (2)Uniformed Services University of the Health Sciences, Bethesda, MD, (3)U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, (4)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (5)Makerere University Walter Reed Project, Kampala, Uganda

Disclosures:

N. K. Copeland, None

M. A. Eller, None

M. Creegan, None

A. Esber, None

T. A. Crowell, Gilead Sciences: Speaker , Speaker honorarium

L. A. Eller, None

M. Semwogerere, None

H. Kibuuka, None

F. Kiweewa, None

F. Cham, None

K. Ganesan, None

C. S. Polyak, None

J. Ake, None

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