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).
m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 1 2 -1Methods: HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapinebased ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks.
Results:We studied 100 patients with HIV ([M -67, F -23], mean age: 40.05 AE 10.75 years, mean CD4 cell count: 239.157 AE 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT ( p = 0.044) and with baseline LFT abnormalities ( p = 0.00016). There was no case of acute liver failure or mortality.
Conclusion:Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.
Background: Hepatitis A is an emerging public health problem worldwide, with alerts issued in developed countries, although it remains under-reported, under-diagnosed, and under-investigated in the developing world. Prolonged epidemics can occur due to person-to-person transmission. The ongoing outbreak of hepatitis A reported in the United States is one of its largest-ever outbreaks of the disease. A public health emergency for hepatitis A was declared in Florida, with over 2000 cases across several regions of The United States, in the year 2019. Methods: The outbreak investigation was carried out on 30 travelers in an Indian Himalayan mountain camp. Clinical features were correlated with laboratory parameters for establishing diagnosis by standard case definition. Line listing and epidemic curve were plotted to corroborate outbreak variables. Clinicodemographic, clinical, laboratory, and outbreak variables were descriptively analyzed. Results: Most of the 30 patients with hepatitis A were young male patients within the age range of 20 - 30 years. The most common clinical features among the case-patients were anorexia and vomiting. The epidemic curve revealed a peak of 15 case-patients from June 22 to July 5, 2019. Liver function tests showed mild derangement in all the case-patients. All the patients required hospitalization, with a mean duration of hospital stay reported as 11.86 ± 2.53 days. All the patients fully recovered with no fatalities. Conclusions: Hepatitis A outbreaks can occur through the consumption of untreated mountain stream/river water due to upstream contamination with human/animal excrements. Strengthening surveillance systems, traveler education, vaccination, and intersectoral coordination for safe water supply remains a necessary public health measure.
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