A Cross-sectional Study of Liver Function Tests in HIV-infected Persons in Western India

Overview

Journal Med J Armed Forces India

Specialty General Medicine

Date 2017 Jan 27

PMID 28123241

Citations 2

Authors

Sunny Pathania

Navjyot Kaur

Sandeep Kumar

V K Sashindran

Pankaj Puri

Affiliations

Soon will be listed here.

Abstract

Background: Derangement of liver function tests (LFTs) is common in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA). The cause is multifactorial. Drug-induced liver injury (DILI) is the commonest cause and others being alcohol abuse and concomitant viral hepatitis. The aim of the research was to study the prevalence of LFT abnormalities in PLHA.

Methods: The study was carried out in a tertiary care hospital. Evaluation included a detailed history, thorough clinical examination and investigations including a haemogram, serum biochemistry, serology for hepatitis, and CD4 cell count.

Results: A total of 247 patients were evaluated. Of these, 212 (85.82%) were on antiretroviral therapy (ART), 111 (44.93%) were on anti-tubercular therapy (ATT), and 94 (38.05%) were on concurrent ATT-ART. Abnormal LFTs were seen in 128/247 (51.82%) PLHA. In the majority (88.28%), the LFT abnormalities were mild. LFT abnormalities were seen in 109/212 (51.4%) patients on ART, in 56/111 (50.5%) patients on ATT, 46/94 (48.93%) patients on concurrent ART-ATT. There was no difference in LFT abnormalities among the three groups nor was there any significant association with alcohol consumption. There was a statistically significant co-relation between albumin/globulin ratio and CD4 count ( = 0.0002). Counter-intuitively, LFT abnormalities were commoner in patients not receiving nevirapine ( = 0.043), but severe abnormalities (grade III/grade IV) were commoner in those receiving nevirapine ( = 0.005) and in those on concurrent ART-ATT ( = 0.008).

Conclusion: LFT abnormalities in PLHA are common; but usually mild. There is a strong association between severe abnormalities and nevirapine-based therapy ( = 0.02) and concurrent ATT-ART ( = 0.008).

Citing Articles

Evolution of Hematobiochemical Profiles in Newly Diagnosed HIV Patients and HIV-TB Co-Infected Patients: Correlation with Immunological and Virological Status.

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References

Alberti A, Clumeck N, Collins S, Gerlich W, Lundgren J, Palu G . Short statement of the first European Consensus Conference on the treatment of chronic hepatitis B and C in HIV co-infected patients. J Hepatol. 2005; 42(5):615-24. DOI: 10.1016/j.jhep.2005.03.003. View

Solomon S, Mehta S, Srikrishnan A, Solomon S, McFall A, Laeyendecker O . Burden of hepatitis C virus disease and access to hepatitis C virus services in people who inject drugs in India: a cross-sectional study. Lancet Infect Dis. 2014; 15(1):36-45. PMC: 4503257. DOI: 10.1016/S1473-3099(14)71045-X. View

Weber R, Sabin C, Friis-Moller N, Reiss P, El-Sadr W, Kirk O . Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006; 166(15):1632-41. DOI: 10.1001/archinte.166.15.1632. View

Bica I, McGovern B, Dhar R, Stone D, McGowan K, Scheib R . Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis. 2001; 32(3):492-7. DOI: 10.1086/318501. View

Sonth S, Satyhanarayana M, Mariraj J, Krishna S . Sero-prevalence of anti-HCV in HIV infected patients. J Commun Dis. 2013; 43(2):151-4. View

Devi K, Singh N, Singh H, Singh Y . Coinfection by human immunodeficiency virus, hepatitis B virus and hepatitis C virus in injecting drug users. J Indian Med Assoc. 2009; 107(3):144, 146-7. View

Puri P, Anand A, Saraswat V, Acharya S, Dhiman R, Aggarwal R . Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part I: Status Report of HCV Infection in India. J Clin Exp Hepatol. 2015; 4(2):106-16. PMC: 4116733. DOI: 10.1016/j.jceh.2014.05.006. View

Chandra N, Joshi N, Raju Y, Kumar A, Teja V . Hepatitis B and/or C co-infection in HIV infected patients: a study in a tertiary care centre from South India. Indian J Med Res. 2014; 138(6):950-4. PMC: 3978987. View

Martin-Carbonero L, Soriano V, Valencia E, Garcia-Samaniego J, Lopez M, Gonzalez-Lahoz J . Increasing impact of chronic viral hepatitis on hospital admissions and mortality among HIV-infected patients. AIDS Res Hum Retroviruses. 2001; 17(16):1467-71. DOI: 10.1089/08892220152644160. View

10.

Palella Jr F, Baker R, Moorman A, Chmiel J, Wood K, Brooks J . Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006; 43(1):27-34. DOI: 10.1097/01.qai.0000233310.90484.16. View

11.

Palella Jr F, Delaney K, Moorman A, Loveless M, Fuhrer J, Satten G . Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998; 338(13):853-60. DOI: 10.1056/NEJM199803263381301. View

12.

Mohsen A, Easterbrook P, Taylor C, Norris S . Hepatitis C and HIV-1 coinfection. Gut. 2002; 51(4):601-8. PMC: 1773386. DOI: 10.1136/gut.51.4.601. View

13.

Sulkowski M . Management of hepatic complications in HIV-infected persons. J Infect Dis. 2008; 197 Suppl 3:S279-93. DOI: 10.1086/533414. View

14.

Price J, Thio C . Liver disease in the HIV-infected individual. Clin Gastroenterol Hepatol. 2010; 8(12):1002-12. PMC: 2997131. DOI: 10.1016/j.cgh.2010.08.024. View

15.

Schneider M, Gange S, Williams C, Anastos K, Greenblatt R, Kingsley L . Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984-2004. AIDS. 2005; 19(17):2009-18. DOI: 10.1097/01.aids.0000189864.90053.22. View

16.

Chaudhry A, Sulkowski M, Chander G, Moore R . Hazardous drinking is associated with an elevated aspartate aminotransferase to platelet ratio index in an urban HIV-infected clinical cohort. HIV Med. 2009; 10(3):133-42. PMC: 2654191. DOI: 10.1111/j.1468-1293.2008.00662.x. View

17.

Sterling R, Chiu S, Snider K, Nixon D . The prevalence and risk factors for abnormal liver enzymes in HIV-positive patients without hepatitis B or C coinfections. Dig Dis Sci. 2007; 53(5):1375-82. PMC: 3836444. DOI: 10.1007/s10620-007-9999-6. View

18.

Nunez M . Clinical syndromes and consequences of antiretroviral-related hepatotoxicity. Hepatology. 2010; 52(3):1143-55. DOI: 10.1002/hep.23716. View

19.

Lebovics E, Dworkin B, Heier S, ROSENTHAL W . The hepatobiliary manifestations of human immunodeficiency virus infection. Am J Gastroenterol. 1988; 83(1):1-7. View

20.

Nagmoti M, Patil C, Jyoti M, Mutnal M, Mallapur M . Prevalence of hepatitis C infection in HIV-seropositive individuals in and around Belgaum, south India. Int J STD AIDS. 2012; 23(10):e14-5. DOI: 10.1258/ijsa.2009.009420. View