Shamanna Suryanarayana Bettadpura, Naik Ramavath Raghu Ramulu, Hamide Abdoul
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605 006, India.
Department of Medicine, Sri Venkateshwara Medical College, Tirupati, Chittoor, 517 520, India.
Indian J Gastroenterol. 2016 Jul;35(4):310-4. doi: 10.1007/s12664-016-0676-6. Epub 2016 Jul 20.
Liver disease in HIV-infected patients has remained unaddressed in India. This study describes the causes of liver disease in HIV-infected patients and short-term outcome in them. Designed as a prospective observational study, it was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research between September 2011 and March 2013. All consecutive HIV patients (>13 years) attending the antiretroviral therapy clinic or admitted in the Medicine Department were screened, and patients with liver disease or with either HBsAg or anti-HCV antibody positivity were included in the study. Of the 198 patients screened, 51 (26 %) had either abnormal liver function test or had HBsAg or anti-HCV positivity. The median age of the patients was 40 years and 82 % were males. The median CD4 count was 123 cells/mm(3). Eighteen (35 %) of them had alcoholic liver disease. Six patients had probable hepatic involvement due to tuberculosis. Ten patients had antituberculosis drug-induced hepatotoxicity. One patient had acute hepatitis B and seven patients had chronic hepatitis B. The cause could not be established in 10 patients (20 %). After a median period of 8 months of follow up, 23 patients had improved, 19 patients (37 %) had died, and six patients had been lost to follow up. Of the patients who had died, 11 patients (58 %) had tuberculosis, and 6 patients (30 %) had decompensated alcoholic liver disease. In conclusion, liver disease in HIV-infected patients was associated with high mortality. Alcohol abuse, tuberculosis, and antituberculosis drugs were the major causes.
在印度，感染艾滋病毒患者的肝脏疾病问题一直未得到解决。本研究描述了感染艾滋病毒患者肝脏疾病的病因及其短期预后情况。该研究为前瞻性观察性研究，于2011年9月至2013年3月在贾瓦哈拉尔研究生医学教育与研究学院开展。对所有连续就诊于抗逆转录病毒治疗门诊或内科住院的艾滋病毒患者（年龄>13岁）进行筛查，将患有肝脏疾病或乙肝表面抗原（HBsAg）阳性或丙肝抗体（抗-HCV）阳性的患者纳入研究。在筛查的198例患者中，51例（26%）肝功能检查异常或HBsAg阳性或抗-HCV阳性。患者的中位年龄为40岁，82%为男性。CD4细胞计数中位数为123个/立方毫米。其中18例（35%）患有酒精性肝病。6例患者可能因结核病累及肝脏。10例患者有抗结核药物所致肝毒性。1例患者患有急性乙型肝炎，7例患者患有慢性乙型肝炎。10例患者（20%）病因不明。经过中位时间8个月的随访，23例患者病情改善，19例患者（37%）死亡，6例患者失访。在死亡的患者中，11例（58%）患有结核病，6例（30%）患有失代偿性酒精性肝病。总之，感染艾滋病毒患者的肝脏疾病与高死亡率相关。酗酒、结核病和抗结核药物是主要病因。
