Marti Amon I, Colombe Soledad, Masikini Peter J, Kalluvya Samuel E, Smart Luke R, Wajanga Bahati M, Jaka Hyasinta, Peck Robert N, Downs Jennifer A
Catholic University of Health and Allied Sciences and Bugando Medical Centre, Mwanza, Tanzania.
Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America.
PLoS Negl Trop Dis. 2017 Aug 17;11(8):e0005867. doi: 10.1371/journal.pntd.0005867. eCollection 2017 Aug.
Little is known about hepatotoxicity in patients with schistosome and HIV co-infections. Several studies have reported increased liver enzymes and bilirubin levels associated with schistosome infection. We investigated whether HIV-infected adults on antiretroviral therapy who had S. mansoni co-infection had a higher prevalence of hepatotoxicity than those without.
METHODOLOGY/PRINCIPAL FINDINGS: We determined the presence and grade of hepatotoxicity among 305 HIV-infected outpatients who had been on medium-term (3-6 months) and long-term (>36 months) antiretroviral therapy in a region of northwest Tanzania where S. mansoni is hyperendemic. We used the AIDS Clinical Trial Group definition to define mild to moderate hepatotoxicity as alanine aminotransferase, alanine aminotransferase, and/or bilirubin elevations of grade 1 or 2, and severe hepatotoxicity as any elevation of grade 3 or 4. We determined schistosome infection status using the serum circulating cathodic antigen rapid test and used logistic regression to determine factors associated with hepatotoxicity. The prevalence of mild-moderate and severe hepatotoxicity was 29.6% (45/152) and 2.0% (3/152) in patients on medium-term antiretroviral therapy and 19.6% (30/153) and 3.3% (5/153) in the patients on long-term antiretroviral therapy. S. mansoni infection was significantly associated with hepatotoxicity on univariable analysis and after controlling for other factors associated with hepatotoxicity including hepatitis B or C and anti-tuberculosis medication use (adjusted odds ratio = 3.0 [1.6-5.8], p = 0.001).
CONCLUSIONS/SIGNIFICANCE: Our work demonstrates a strong association between S. mansoni infection and hepatotoxicity among HIV-infected patients on antiretroviral therapy. Our study highlights the importance of schistosome screening and treatment for patients starting antiretroviral therapy in schistosome-endemic settings. Additional studies to determine the effects of schistosome-HIV co-infections are warranted.
关于血吸虫病与艾滋病病毒合并感染患者的肝毒性，人们了解甚少。多项研究报告称，血吸虫感染会导致肝酶和胆红素水平升高。我们调查了接受抗逆转录病毒治疗的艾滋病病毒感染成人中，曼氏血吸虫合并感染患者的肝毒性患病率是否高于未合并感染者。
方法/主要发现：在坦桑尼亚西北部曼氏血吸虫高度流行地区，我们确定了305名接受中期（3 - 6个月）和长期（>36个月）抗逆转录病毒治疗的艾滋病病毒感染门诊患者中肝毒性的存在情况和分级。我们采用艾滋病临床试验组的定义，将轻度至中度肝毒性定义为丙氨酸氨基转移酶、天冬氨酸氨基转移酶和/或胆红素升高至1级或2级，将重度肝毒性定义为任何3级或4级升高。我们使用血清循环阴极抗原快速检测法确定血吸虫感染状况，并使用逻辑回归分析来确定与肝毒性相关的因素。中期抗逆转录病毒治疗患者中轻度至中度和重度肝毒性的患病率分别为29.6%（45/152）和2.0%（3/152），长期抗逆转录病毒治疗患者中分别为19.6%（30/153）和3.3%（5/153）。在单变量分析以及控制了其他与肝毒性相关的因素（包括乙型或丙型肝炎以及抗结核药物使用情况）后，曼氏血吸虫感染与肝毒性显著相关（调整后的优势比 = 3.0 [1.6 - 5.8]，p = 0.001）。
结论/意义：我们的研究表明，在接受抗逆转录病毒治疗的艾滋病病毒感染患者中，曼氏血吸虫感染与肝毒性之间存在密切关联。我们的研究强调了在血吸虫病流行地区，对开始抗逆转录病毒治疗的患者进行血吸虫病筛查和治疗的重要性。有必要开展更多研究以确定血吸虫病与艾滋病病毒合并感染的影响。
