Prevalence and predictors of liver disease in HIV-infected children and adolescents

Abstract

Liver disease in HIV-infected patients may result from the infection itself, antiretroviral treatment or comorbidities. In this study, we analysed liver disease in 79 HIV-infected children and adolescents aged 14.0 ± 5.1 years. All the patients were receiving combination antiretroviral therapy (cART), with a mean duration of 11.5 ± 4.7 years. Six patients (8%) had detectable HIV viral load, and 8/79 (10%) of the participants were coinfected with hepatitis B or C virus (HCV, 6/8 or HBV, 2/8). Liver disease was defined as an elevation of any of the following parameters: alanine or aspartate aminotransferase (ALT and AST), total bilirubin, and gamma glutamyl transferase (GGTP). For the noninvasive evaluation of liver fibrosis, the AST-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) were calculated. Liver disease was diagnosed in 20/79 (25%) of the patients, including 13/71 (18%) of participants without coinfection and 7/8 (88%) with coinfection (p < 0.0001). All of the liver markers except bilirubin were significantly higher in the coinfected group. APRI scores indicated significant fibrosis in 5/8 (63%) of patients with coinfection. HBV or HCV coinfection and detectable HIV viral load were independently positively associated with APRI (p = 0.0001, and p = 0.0001) and FIB-4 (p = 0.001, and p = 0.002, respectively). In conclusion, liver disease in HIV-infected children and adolescents results mainly from HBV or HCV coinfection. Effective antiretroviral treatment is protective against hepatic abnormalities.

Hepatic and renal toxicity and associated factors among HIV‐infected children on antiretroviral therapy: a prospective cohort study

“…They can also lead to organ failure, resulting in increased mortality and morbidity and a lower quality of life . Our finding that a quarter of the children had an abnormal liver enzyme test at enrolment is similar to findings from previous studies .…”

“…They can also lead to organ failure, resulting in increased mortality and morbidity and a lower quality of life [32]. Our finding that a quarter of the children had an abnormal liver enzyme test at enrolment is similar to findings from previous studies [5,10]. Studies have reported that TDF-containing regimens are associated with renal function abnormalities, including persistent renal disease (PRD) [33][34][35][36].…”

“…Following published analytic recommendations for noninvasive assessment of liver fibrosis using the AST to platelet ratio index (APRI) and the fibrosis score (FIB‐4) , we assessed liver cirrhosis and fibrosis. An APRI > 0.5 and FIB‐4 > 1.45 were taken as the cut‐off values for fibrosis, while APRI > 1.5 was considered to indicate cirrhosis . The following formulae were used to calculate the APRI (Eqn ) and FIB values (Eqn ): …”

Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

“…A high prevalence (32.6%) was also found in Thailand among young people perinatally infected with HIV (mean age 14 years) . Prevalence was lower (~2%) among samples in India, Malawi, Poland, Spain and the United States, among HIV‐positive paediatric patients. Prevalence was higher in Benin (9.6%), Rwanda (6.8%), Tanzania (7%) and Zambia (10.4%) among children <16 years recruited through HIV clinics .…”

Hepatitis B virus drug resistance mutations in HIV/HBV co-infected children in Windhoek, Namibia

“…Aspartate aminotransferase (AST) and platelet count were measured using the Architect c8000 (Abbott Laboratories, USA) and ABX Pentra XL80 (Horiba, Japan), respectively, for Aspartate aminotransferase to platelet ratio (APRI) scores calculations. An APRI score > 0.5 was suggestive of liver damage [18,19].…”