Liver Histological Patterns among HIV-Infected Individuals and Associated Factors of Fibrosis in Northwestern Tanzania: Is There a Role for Non-Invasive Tests?

Background: There is a paucity of data on HIV related liver pathologies and fibrosis in Tanzania, a lower middle income country, where there is a high burden of HIV and empirical treatment is the norm due to lack of investigative and management guidelines. This study aimed to determine the liver histological patterns among HIV-infected individuals and associated factors of fibrosis, as well as the role of non-invasive tests in the detection of fibrosis. Patients and Methods: This was an analytical cross-sectional hospital-based study carried out in Mwanza, Tanzania. HIV-infected individuals with suspected but indeterminate liver disease underwent ultrasound guided liver biopsy to determine histological patterns. Non-invasive tests, APRI and FIB-4, were com-pared with ultrasound-guided liver biopsy in the detection of fibrosis. Logistic regression analyses were performed to assess the association between outcome and exposure variables with a p-value ＜ 0.05 considered statistically significant. Receiver operating characteristic curve analyses were used to compare APRI and FIB-4 performance against ultrasound-guided liver biopsy for the detection of liver fibrosis. Results: A total of 86 participants underwent an ultrasound-guided biopsy and specimen for histopathology. Around 98% of the study participants had histological abnormalities. There was underlying fibrosis in 54.7% of the participants with the second most common histological pattern being chronic hepatitis (48.9%). Other patterns included malignancy (24.4%) with the majority having hepatocellular carcinoma (HCC). Steatosis or steatohepatitis was present in 17.4%. Granulomatous inflammation was seen in 13.9% with the majority being tuberculous in origin. APRI and FIB-4 reported a lower proportion of fibrosis compared to histology. Advanced age (OR = 4.78, 95% CI =1.64 - 13.91), presence of jaundice (OR = 3.59, 95% CI = 1.27 - 10.16) or hepatomegaly (OR = 3.56, 95% CI = 1.25 - 10.16) were independent predictors of fibrosis. On receiver operating characteristic analyses, FIB-4 performed marginally better than APRI in detecting fibrosis in comparison to histology (AUC = 0.56, 95% CI = 0.46 - 0.67 vs. AUC = 0.51, 95% CI = 0.39 - 0.61). Conclusions and Recommendation: Fibrosis is the most prevalent histological pattern among HIV-infected individuals. FIB-4 performed better than APRI as a non-invasive test for detecting fibrosis in comparison to histology. We recommend non-invasive tests for screening underlying fibrosis in HIV-infected individuals.