Prevalence and factors associated with liver fibrosis among adult HIV-infected patients attending urban and rural care clinics in Uganda

Background: Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. 

Methods: This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM)>7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. 

Results: Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P =. 017). History of tobacco use (urban P =. 022; rural P =. 035) and serologic evidence of hepatitis C infection (HCV; urban P =. 028; rural P =. 03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P =. 002; rural P =. 028) and increasing age (urban P =. 008; rural P =. 052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P =. 003), and detectable HIV viral load (P =. 002) for men in the urban clinic. 

Conclusions: Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.