{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:37:06Z","timestamp":1792103826351,"version":"4.4.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>There is a heavy burden of liver disease in West Africa. While the role of hepatitis B virus (HBV) infection is well recognized, less is known about the contributing role of liver steatosis and how the two interact in the context of human immunodeficiency virus (HIV) infection. Adults with HIV in Ghana underwent FibroScan measurements to determine prevalence of liver steatosis (expressed as controlled attenuation parameter [CAP]) and fibrosis (expressed as liver stiffness [LS]). We explored contributing factors in linear regression models, including demographics, lifestyle characteristics, medical history, HIV and HBV status, and measurements of metabolic syndrome. Among 329 adults (72.3% women; median age, 47\u2009years), 322 (97.9%) were on antiretroviral therapy (median duration, 8.9\u2009years). CD4 counts were preserved (median, 619 cells\/mm<jats:sup>3<\/jats:sup>); plasma HIV RNA was fully suppressed in 162 (50.3%) of the treated participants. Cigarette smoking, excessive alcohol consumption, and use of traditional or herbal remedies were uncommon (6.1%, 1.8%, 3.3%, respectively). Largely undiagnosed metabolic syndrome was detected in 87 (26.4%) participants. We obtained readings indicative of \u2265S2 steatosis and \u2265F2 fibrosis in 43 (13.1%) and 55 (16.7%) participants, respectively. Higher CAP values were associated with metabolic syndrome and longer prior stavudine exposure. Higher LS values were associated with male sex, higher HIV RNA, and higher CAP values. Relative to people without HBV, those with HBV (<jats:italic toggle=\"yes\">n<\/jats:italic>\u00a0=\u00a090) had a similar prevalence of \u2265S2 steatosis but a higher prevalence of \u2265F2 fibrosis (36.7% vs. 9.2%, <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;\u20090.0001) and concomitant \u2265S2 steatosis and \u2265F2 fibrosis (9.1% vs. 1.3%, <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;\u20090.001). <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: Both HBV and liver steatosis pose a threat to long\u2010term liver health among people with HIV in West Africa. Urgently required interventions include improving HIV suppression and diagnosing and managing determinants of the metabolic syndrome.<\/jats:p>","DOI":"10.1002\/hep4.2000","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T16:39:13Z","timestamp":1663173553000},"page":"3036-3051","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Liver steatosis and fibrosis in people with human immunodeficiency virus in West Africa and the relationship with hepatitis B virus coinfection"],"prefix":"10.1097","volume":"6","author":[{"given":"Giovanni","family":"Villa","sequence":"first","affiliation":[{"name":"Department of Global Health and Infection, Brighton and Sussex Medical School,University of Sussex,Brighton,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-5870","authenticated-orcid":false,"given":"Dorcas","family":"Owusu","sequence":"additional","affiliation":[{"name":"Department of Theoretical and Applied Biology,Kwame Nkrumah University of Science and Technology,Kumasi,Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colette","family":"Smith","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Epidemiology, Modelling and Evaluation,Institute for Global Health, University College London,London,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Azumah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Komfo Anokye Teaching Hospital,Kumasi,Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Abdullahi","sequence":"additional","affiliation":[{"name":"Cambridge Institute of Therapeutic Immunology and Infectious Disease,University of Cambridge,Cambridge,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzannah","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Liverpool Clinical Laboratories,Liverpool University Hospitals National Health Service Foundation Trust,Liverpool,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Sayeed","sequence":"additional","affiliation":[{"name":"Centre for Clinical Infection,James Cook University Hospital,Middlesbrough,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology,University of Liverpool,Liverpool,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chadwick","sequence":"additional","affiliation":[{"name":"Centre for Clinical Infection,James Cook University Hospital,Middlesbrough,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Odame","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine and Dentistry,Kwame Nkrumah University of Science and Technology,Kumasi,Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3670-6588","authenticated-orcid":false,"given":"Anna Maria","family":"Geretti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases,Fondazione PTV and University of Rome Tor Vergata,Rome,Italy"},{"name":"Department of Infectious Diseases, School of Immunity and Microbial Sciences,King\u2019s College London,London,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"hep42000-bib-0001-20241104","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1097\/QAD.0000000000001504","article-title":"Prevalence and risk factors of nonalcoholic fatty liver disease in HIV\u2010monoinfection","volume":"31","year":"2017","journal-title":"AIDS."},{"key":"hep42000-bib-0002-20241104","article-title":"Risk factors associated with chronic liver enzyme elevation in persons with HIV without hepatitis B or C coinfection in the combination antiretroviral therapy era","volume":"8","year":"2021","journal-title":"Open Forum Infect Dis."},{"key":"hep42000-bib-0003-20241104","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.cld.2018.12.011","article-title":"Liver disease in human immunodeficiency virus infection","volume":"23","year":"2019","journal-title":"Clin Liver Dis"},{"key":"hep42000-bib-0004-20241104","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1080\/17474124.2019.1614913","article-title":"Nonalcoholic fatty liver disease and steatohepatitis in people living with HIV","volume":"13","year":"2019","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"hep42000-bib-0005-20241104","article-title":"Predictive factors associated with liver fibrosis and steatosis by transient elastography in patients with HIV mono\u2010infection under long\u2010term combined antiretroviral therapy","volume":"21","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"hep42000-bib-0006-20241104","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/S2468-1253(21)00296-X","article-title":"Health\u2010care provision and policy for non\u2010alcoholic fatty liver disease in sub\u2010Saharan Africa","volume":"6","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"hep42000-bib-0007-20241104","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/S2468-1253(21)00275-2","article-title":"Epidemiology, risk factors, social determinants of health, and current management for non\u2010alcoholic fatty liver disease in sub\u2010Saharan Africa","volume":"6","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"hep42000-bib-0008-20241104","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1002\/hep.27710","article-title":"A clinicopathological cohort study of liver pathology in 301 patients with human immunodeficiency virus\/acquired immune deficiency syndrome","volume":"61","year":"2015","journal-title":"Hepatology"},{"key":"hep42000-bib-0009-20241104","article-title":"Tuberculosis and hepatic steatosis are prevalent liver pathology findings among HIV\u2010infected patients in South Africa","volume":"10","year":"2015","journal-title":"PLoS ONE"},{"key":"hep42000-bib-0010-20241104","first-page":"151","article-title":"Fatty liver and hyperlipidemia in a cohort of HIV\u2010positive Africans on highly active antiretroviral therapy","volume":"101","year":"2009","journal-title":"J Natl Med Assoc"},{"key":"hep42000-bib-0011-20241104","first-page":"353","article-title":"Lipodystrophy and echographic hepatic steatosis in HIV\u2010positive patients under highly active antiretroviral therapy (HAART) in Yaounde (Cameroon)","volume":"105","year":"2012","journal-title":"Bull Soc Pathol Exot"},{"key":"hep42000-bib-0012-20241104","first-page":"279","article-title":"Abdominal ultrasound abnormalities incidentally discovered in patients with asymptomatic HIV in Lome (Togo)","volume":"24","year":"2014","journal-title":"Med Sante Trop"},{"key":"hep42000-bib-0013-20241104","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/cid\/civ421","article-title":"Liver fibrosis by transient elastography and virologic outcomes after introduction of tenofovir in lamivudine\u2010experienced adults with HIV and hepatitis B virus coinfection in Ghana","volume":"61","year":"2015","journal-title":"Clin Infect Dis"},{"key":"hep42000-bib-0014-20241104","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1053\/j.gastro.2019.01.042","article-title":"Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with non\u2010alcoholic fatty liver disease","volume":"156","year":"2019","journal-title":"Gastroenterology"},{"key":"hep42000-bib-0015-20241104","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1097\/QAI.0000000000001936","article-title":"Diagnostic accuracy of noninvasive markers of steatosis, NASH and liver fibrosis in HIV\u2010monoinfected individuals at\u2010risk of non\u2010alcoholic fatty liver disease (NAFLD): results from the ECHAM study","volume":"80","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"hep42000-bib-0016-20241104","doi-asserted-by":"crossref","first-page":"3223","DOI":"10.1128\/JCM.02231-09","article-title":"Detection of highly prevalent hepatitis B virus coinfection among HIV\u2010seropositive persons in Ghana","volume":"48","year":"2010","journal-title":"J Clin Microbiol"},{"key":"hep42000-bib-0018-20241104","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jhep.2016.12.022","article-title":"Individual patient data meta\u2010analysis of controlled attenuation parameter (CAP) technology for assessing steatosis","volume":"66","year":"2017","journal-title":"J Hepatol"},{"issue":"Suppl 1","key":"hep42000-bib-0019-20241104","first-page":"129","article-title":"Baseline prevalence and predictors of liver fibrosis among HIV\u2010positive individuals: a substudy of the INSIGHT strategic timing of AntiRetroviral treatment (START) trial","volume":"16","year":"2015","journal-title":"HIV Med"},{"key":"hep42000-bib-0020-20241104","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1365-2893.2010.01275.x","article-title":"Proficiency of transient elastography compared to liver biopsy for the assessment of fibrosis in HIV\/HBV\u2010coinfected patients","volume":"18","year":"2011","journal-title":"J Viral Hepat"},{"key":"hep42000-bib-0021-20241104","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jviromet.2012.05.008","article-title":"Development and validation of an efficient in\u2010house real\u2010time reverse transcription polymerase chain reaction assay for the quantitative detection of serum hepatitis delta virus RNA in a diverse South London population","volume":"184","year":"2012","journal-title":"J Virol Methods."},{"key":"hep42000-bib-0022-20241104","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C","volume":"38","year":"2003","journal-title":"Hepatology"},{"key":"hep42000-bib-0023-20241104","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","year":"2006","journal-title":"Hepatology"},{"key":"hep42000-bib-0025-20241104","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","year":"2009","journal-title":"Circulation"},{"key":"hep42000-bib-0027-20241104","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.1210\/jc.2011-3213","article-title":"Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline","volume":"97","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"hep42000-bib-0029-20241104","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance","volume":"67","year":"2018","journal-title":"Hepatology"},{"key":"hep42000-bib-0030-20241104","article-title":"Prevalence of metabolic syndrome among HIV\u2010positive and HIV\u2010negative populations in sub\u2010Saharan Africa\u2014a systematic review and meta\u2010analysis","volume":"8","year":"2019","journal-title":"Syst Rev"},{"key":"hep42000-bib-0031-20241104","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1111\/jch.13561","article-title":"Characteristics of hypertension among people living with HIV in Ghana: impact of new hypertension guideline","volume":"21","year":"2019","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"hep42000-bib-0032-20241104","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jash.2017.06.004","article-title":"Global prevalence of hypertension among people living with HIV: a systematic review and meta\u2010analysis","volume":"11","year":"2017","journal-title":"J Am Soc Hypertens"},{"key":"hep42000-bib-0033-20241104","article-title":"Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub\u2010Saharan Africa and the UK: analysis of four population studies","volume":"6","year":"2021","journal-title":"BMJ Glob Health"},{"key":"hep42000-bib-0034-20241104","article-title":"Drug\u2010induced liver steatosis in patients with HIV infection","volume":"145","year":"2019","journal-title":"Pharmacol Res"},{"key":"hep42000-bib-0035-20241104","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1097\/01.qai.0000137004.63376.27","article-title":"Mitochondrial dysfunction: patient monitoring and toxicity management","volume":"37","year":"2004","journal-title":"J Acquir Immune Defic Syndr"},{"key":"hep42000-bib-0036-20241104","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/j.1440-1746.2011.06801.x","article-title":"Hepatic steatosis in hepatitis B virus infected patients: meta\u2010analysis of risk factors and comparison with hepatitis C infected patients","volume":"26","year":"2011","journal-title":"J Gastroenterol Hepatol"},{"key":"hep42000-bib-0037-20241104","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3748\/wjg.v27.i4.336","article-title":"Clinic\u2010pathological features of metabolic associated fatty liver disease with hepatitis B virus infection","volume":"27","year":"2021","journal-title":"World J Gastroenterol"},{"key":"hep42000-bib-0038-20241104","article-title":"Inverse association between hepatitis B virus infection and fatty liver disease: a large\u2010scale study in populations seeking for check\u2010up","volume":"8","year":"2013","journal-title":"PLoS ONE"},{"key":"hep42000-bib-0039-20241104","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.14309\/ajg.0000000000001257","article-title":"Hepatic steatosis and steatohepatitis in a large north American cohort of adults with chronic hepatitis B","volume":"116","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"hep42000-bib-0040-20241104","doi-asserted-by":"crossref","first-page":"e3275","DOI":"10.1093\/cid\/ciaa1303","article-title":"Fatty liver disease in a prospective North American cohort of adults with human immunodeficiency virus and hepatitis B virus coinfection","volume":"73","year":"2021","journal-title":"Clin Infect Dis"},{"key":"hep42000-bib-0041-20241104","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/cid\/cix122","article-title":"Impact of antiretroviral therapy on liver fibrosis among human immunodeficiency virus\u2010infected adults with and without HBV coinfection in Zambia","volume":"64","year":"2017","journal-title":"Clin Infect Dis"},{"key":"hep42000-bib-0042-20241104","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1002\/hep.26761","article-title":"Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis","volume":"59","year":"2014","journal-title":"Hepatology"},{"key":"hep42000-bib-0043-20241104","article-title":"Determining virological suppression and resuppression by point\u2010of\u2010care viral load testing in a HIV care setting in sub\u2010Saharan Africa","volume":"18","year":"2020","journal-title":"EClinicalMedicine"},{"key":"hep42000-bib-0044-20241104","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41575-018-0085-7","article-title":"HIV and the liver","volume":"16","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep4.2000","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep4.2000","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.2000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T08:00:21Z","timestamp":1730707221000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.2000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,14]]},"references-count":40,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1002\/hep4.2000","relation":{},"ISSN":["2471-254X","2471-254X"],"issn-type":[{"value":"2471-254X","type":"print"},{"value":"2471-254X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,14]]},"assertion":[{"value":"2021-12-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}