Liver cirrhosis in HIV‐infected patients: prevalence, aetiology and clinical outcome

Abstract

Liver disease is frequently seen in HIV+ patients as a result of coinfection with hepatitis B (HBV) or C (HCV) viruses, alcohol abuse and/or exposure to hepatotoxic drugs. The aim of this study was to assess the prevalence of liver cirrhosis, its main causes and clinical presentation in HIV+ patients. Observational, cross-sectional, retrospective study of all HIV+ individuals followed at one reference HIV outpatient clinic in Madrid. Liver fibrosis was measured in all cases using transient elastometry (FibroScan). All 2168 HIV+ patients on regular follow-up (76% males, 46% injecting drug users) were successfully examined by FibroScan) between October 2004 and August 2006. Liver cirrhosis was recognized in 181 (overall prevalence, 8.3%), and the main aetiologies were HCV, 82.3%; HBV, 1.6%; dual HBV/HCV, 2.8%; and triple HBV/HCV/ hepatitis delta virus (HDV) infection, 6.6%. The prevalence of cirrhosis differed among patients with distinct chronic viral hepatitis: HCV, 19.2%; HBV, 6.1%; HBV/HCV, 41.7%; and HBV/HCV/HDV, 66.7%. In 12 patients with cirrhosis (6.7%), no definite aetiology was recognized. Overall, cirrhotics had lower mean CD4 counts than noncirrhotics (408 vs 528 cells/microL respectively; P = 0.02), despite similar proportion of subjects with undetectable viraemia on highly active antiretroviral therapy. Clinical manifestations of liver cirrhosis were: splenomegaly, 61.5%; oesophageal varices, 59.8%; ascites, 22.6%; encephalopathy, 12.1%; and variceal bleeding, 6.1%. Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV+ individuals. Chronic HCV and alcohol abuse, but not chronic HBV, play a major role. Transient elastometry may allow the identification of a significant number of HIV+ individuals with asymptomatic liver cirrhosis.

Trends in mortality and antibiotic resistance among HIV‐infected patients with invasive pneumococcal disease

“…The prevalence and prognosis of comorbidities may vary according to the characteristics of HIV transmission and the type of comorbidities. For example, some reports have documented a high prevalence of hepatitis C virus coinfection often complicated with liver cirrhosis, particularly in injecting drug users, and this was associated with poor prognosis [22,26,27]. In our study the most frequent comorbidity was liver cirrhosis, which was independently associated with increased mortality in a separate analysis.…”

“…It is well known that in the HAART era many HIV-infected patients have developed associated comorbidities such as chronic liver disease, diabetes, cancer and cardiovascular disease [10,[22][23][24][25][26][27], and the present study shows that comorbidities are independently associated with mortality in this population. The prevalence and prognosis of comorbidities may vary according to the characteristics of HIV transmission and the type of comorbidities.…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…(a) HCV therapy can be potentially dangerous in those with severe liver disease, particularly cirrhosis Child-Pugh stage B/C, as deaths have occurred [201,203,204]. (b) There is less chance of an SVR [196,201,202,205].…”

“…Patients should abstain from or minimize alcohol intake, as more rapid progression of liver disease is seen with higher levels of alcohol consumption [85,203]. Patients who are nonimmune for HAV and HBV should be vaccinated, as superinfection of HCV-infected patients with HAV or HBV can be life-threatening (see General section).…”

Insulin resistance in diabetes mellitus due to chronic liver disease and retroviral infection

“…It is also seen in diabetic patients having cirrhosis of liver and retroviral infection [2]. We report a case of a 52 year old business man from rural area, known to have Type 2 DM and Chronic liver disease-Ethanol induced and Hepatitis B virus positive on treatment for 2 years, presented with fatigability and cough was evaluated.…”