Phinius Bonolo B, Anderson Motswedi, Bhebhe Lynnette, Baruti Kabo, Manowe Godiraone, Choga Wonderful T, Mupfumi Lucy, Mbangiwa Tshepiso, Mudanga Mbatshi, Moyo Sikhulile, Marlink Richard, Blackard Jason T, Gaseitsiwe Simani
Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana.
Department of Biological Sciences, Faculty of Sciences, University of Botswana, Gaborone 0000, Botswana.
Pathogens. 2020 Nov 14;9(11):950. doi: 10.3390/pathogens9110950.
People with concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) have an increased risk of hepatotoxic reactions due to antiretroviral therapy (ART) and anti-TB therapy (ATT). Concomitant hepatitis B virus (HBV) in these patients may lead to poorer health outcomes. To assess liver enzyme levels and immune response in adults with HIV, HBV, and TB, data from 300 antiretroviral-naïve people living with HIV (PLWHIV) were analyzed. The prevalence of HIV/HBV (cHIV/HBV) and HIV/TB (cHIV/TB) was 28% (95% CI: 23.0-33.4) and 10% (95% CI: 6.8-14.0), respectively. HIV/HBV/TB (cHIV/HBV/TB) prevalence was 5.3% (95% CI: 3.1-8.5). There was a statistically significant difference between the groups of participants in HIV viral load ( = 0.004), hemoglobin levels ( = 0.025), and body mass index ( = 0.011). A larger proportion of cHIV/HBV/TB participants (37.5%) had an aspartate aminotransferase to platelet ratio index (APRI) score ≥0.5 ( = 0.013), a lower cutoff for significant liver fibrosis. Immunological non-responders (CD4+ T-cell count <20% gain and HIV viral load <400 copies/mL at 6 months) were observed in all groups except those with cHIV/TB. Our findings support the need to screen for infections that could cause excessive liver damage prior to ATT or ART initiation, such as HBV.
合并感染人类免疫缺陷病毒（HIV）和结核病（TB）的患者，因抗逆转录病毒疗法（ART）和抗结核疗法（ATT）而发生肝毒性反应的风险增加。这些患者合并感染乙型肝炎病毒（HBV）可能导致更差的健康结局。为评估成人HIV、HBV和TB感染者的肝酶水平及免疫反应，分析了300例未接受过抗逆转录病毒治疗的HIV感染者（PLWHIV）的数据。HIV/HBV（cHIV/HBV）和HIV/TB（cHIV/TB）的患病率分别为28%（95%CI：23.0 - 33.4）和10%（95%CI：6.8 - 14.0）。HIV/HBV/TB（cHIV/HBV/TB）患病率为5.3%（95%CI：3.1 - 8.5）。各参与者组在HIV病毒载量（ = 0.004）、血红蛋白水平（ = 0.025）和体重指数（ = 0.011）方面存在统计学显著差异。更大比例的cHIV/HBV/TB参与者（37.5%）的天冬氨酸转氨酶与血小板比值指数（APRI）评分≥0.5（ = 0.013），这是显著肝纤维化的较低临界值。除cHIV/TB组外，所有组均观察到免疫无应答者（6个月时CD4 + T细胞计数增加<20%且HIV病毒载量<400拷贝/mL）。我们的研究结果支持在开始ATT或ART之前筛查可能导致过度肝损伤的感染，如HBV。
