Integrated Assessment of Liver Disease Severity and Viral Load in Human Immunodeficiency Virus–Hepatitis B Virus Coinfected Individuals: Utilizing Aspartate Aminotransferase/Platelet Ratio Index and FIB-4 Biomarkers Alongside Real-time Polymerase Cha

Abstract Introduction: Hepatitis B virus (HBV) is a DNA virus that causes liver fibrosis (FIB), inflammation, and cancer. Accurate FIB assessment is the key to managing chronic liver disease. Noninvasive biomarkers like FIB-4 (based on age, aspartate aminotransferase [AST], alanine aminotransferase, and platelets) and AST/platelet ratio index (APRI) (AST to platelet ratio) are widely used. This study assessed the accuracy of APRI, FIB-4, and HBV DNA in detecting advanced FIB in human immunodeficiency virus (HIV)–HBV coinfected patients on antiretroviral therapy (ART), as well as in HBV mono-infected patients. Materials and Methods: 100 HIV–HBV coinfected and 50 HBV mono infected patients were recruited in this study after taking informed consent, presenting to ART center and medicine outpatient departments of our tertiary care center, respectively. Results: A total of 100 patients, divided into two groups: 50 mono-infected with HBV and 50 coinfected with HIV and HBV were included. FIB-4 score were F0–F1, n = 19; F2, n = 9; F3, n = 22 in HIV–HBV coinfected patients whereas HBV mono-infected patients had F0–F1, n = 17; F2, n = 7 and F3, n = 26. APRI score were > 0.7, n = 88%; <0.7 and ≤ 1.5, n = 8%; <2, n = 4% in HIV–HBV coinfected patients and > 0.7, n = 44%; <0.7 and ≤ 1.5, n = 42%; <2, n = 14% in HBV mono-infected patients. High HBV viral load was seen in patients having elevated FIB-4. Also, patients with mono-infected HBV were having symptomatic hepatic disease as compared to HIV–HBV coinfected patients who were generally asymptomatic. Conclusions: FIB-4 and APRI are feasible tools for managing HIV–HBV coinfected patients in resource-limited settings. Routine HBV screening, liver enzyme checks, and FIB assessment using APRI and FIB-4 should be integrated into ART initiation and ongoing care for HIV-positive individuals.