ArticleLiver international : official journal of the International Association for the Study of the Liver2015
Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 18 citations in OpenAlex.
- Multidrug resistant tuberculosis (MDR-TB) in Eritrea: a retrospective cohort analysis of mortality and associated factors (2013 - 2023).Frontiers in cellular and infection microbiology · 2026Article
- LDH to lymphocyte percentage ratio is a novel predictor of in-hospital mortality in PLWH - a retrospective study.BMC infectious diseases · 2025Observational
- Biomarkers for Assessment of Human Immunodeficiency Virus and its Co-Infection with Hepatitis B and Hepatitis C Viruses: A Comprehensive Review.Iranian journal of pathology · 2023Review
- Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana.Pathogens (Basel, Switzerland) · 2020Article
- HIV, syphilis and hepatitis B coinfections in Mkushi, Zambia: a cross-sectional study.F1000Research · 2019Article
- Role of Noncommunicable Diseases (NCDs) in Resource-Limited Settings (RLS).Current HIV/AIDS reports · 2018Review
- Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.Health research policy and systems · 2017Review
- Association of serum albumin and aspartate transaminase with 5-year all-cause mortality in HIV/hepatitis C virus coinfection and HIV monoinfection.AIDS (London, England) · 2017Article
- Hepatitis B testing and treatment in HIV patients in The Gambia-Compliance with international guidelines and clinical outcomes.PloS one · 2017Article
- Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia.Tropical medicine & international health : TM & IH · 2016Article
- Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2016Article
- Prevalence and Outcomes of Hepatitis B Coinfection and Associated Liver Disease Among Antiretroviral Therapy-Naive Individuals in a Rural Tanzanian Human Immunodeficiency Virus Cohort.Open forum infectious diseases · 2016Article
- Response to 'Is AST-to-platelet ratio index a reliable tool in HIV patients in Africa?'.Liver international : official journal of the International Association for the Study of the Liver · 2015Article
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10 authors at 5 institutions in 3 countries.
Funding
Abstract
BACKGROUND &
aimsWe investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia.
methodsAmong HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunological status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART.
resultsAmong 20 308 adults in the analysis cohort, 1027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4(+) count <200 cells/mm(3) , and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71-10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21-1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31-1.89) were associated with increased all-cause mortality.
conclusionLiver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings.
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