The Impact of the Severity of HIV Infection on the Prevalence of Liver Fibrosis in Children

Background: The fibrotic process in liver fibrosis is faster when there is coinfection with HIV than in Hepatitis B or Hepatitis C mono-infection. Objectives: We sought to compare the presence of liver fibrosis based on Aspartate Aminotransferase to Platelet Ratio Index (APRI) in HIV clinical stage I-II and III-IV. We also sought to identify factors associated with liver fibrosis in HIV-infected children. Methods: The population was HIV-infected children who were registered in 2006-2014 Sanglah hospital’s TApHOd (Treat Asia Pediatric HIV Observational Database) cohort. The cutoff point for fibrosis was APRI > 0.5. The sample was grouped into two outcomes: liver fibrosis and without fibrosis. The associations of liver fibrosis to the severity of HIV clinical stage and other variables were analyzed using Fisher-Exact test. Results: From 81 HIV-infected subjects, 46 were in stage III-IV and 35 in stage I-II. The range of APRI was 0.11 to 12.01. There were 27 subjects with liver fibrosis. There were 21 subjects with liver fibrosis in stage III-IV HIV infection and 6 in stage I-II. The analysis showed in a group of liver fibrosis patients; there are more patients with the severe clinical stage of HIV (p-value = 0.009). Conclusion: Liver fibrosis is more common in the more severe clinical stage of HIV infection in children than in the milder clinical stage. Advanced clinical stage significantly increases the risk for liver fibrosis.