Ivano-Frankivsk National Medical University (Ivano-Frankivsk, Ukraine).
Folia Parasitol (Praha). 2020 Nov 27;67:2020.034. doi: 10.14411/fp.2020.034.
Liver pathologies and infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) are widespread among HIV-infected patients. However, a possible contribution of toxoplasmosis to the development of various forms of liver diseases in HIV-infected individuals has not yet been determined. This research is a retrospective cohort study. Medical cards of 907 HIV-positive patients, including 119 individuals who died, were studied. The patients were divided into two groups: 531 patients were seropositive to T. gondii and 376 seronegative. General liver pathology was more widespread among patients seropositive to T. gondii than in seronegative patients (63.1 ± 2.1% and 51.9 ± 2.6%, respectively, p < 0.001). The association of seropositive to T. gondii with general liver pathology is weak both in the whole cohort (Pearson's contingency coefficient C = 0.112), and among the deceased patients (C = 0.228). Chronic HBV-HCV coinfection was more common in the seropositive than in seronegative individuals as it was found both in entire cohorts (26.0 ± 1.9% and 18.6 ± 2.0%, respectively, p = 0.010) and in died patients (31.0 ± 5.5% and 14.6 ± 5.1%, respectively, p = 0.041). Toxoplasma gondii had a weak role in distributing of HBV-HCV coinfection between cohorts (C = 0.187). In both cohorts in patients with chronic hepatitis, regardless of its etiology, there was no significant difference in alanine transaminase activity (ALT). Cirrhosis of the liver occurred 4.5 times more often in deceased seropositive patients than in the entire seropositive cohort (23.9 ± 5.1 and 5.3 ± 2.0, respectively, p = 0.0006) whereas it no significantly increased in seronegative cohort (10.4 ± 4.4 against 4.8 ± 1.1, p > 0.05). In them T. gondii is weakly involved in cirrhosis formation (C = 0.168). Thus, in HIV-infected patients, T. gondii is a weak nonspecific adjunct that supports chronic liver inflammation and progression of cirrhosis, regardless of etiology, but does not influence the degree of hepatitis activity. The increased prevalence of HBV-HCV coinfection in patients seropositive for T. gondii may be related to their risk factor behaviour associated with uncontrolled blood contacts.
在 HIV 感染患者中，肝病理学和刚地弓形虫（Nicolle et Manceaux，1908）感染非常普遍。然而，尚未确定弓形虫病是否会导致 HIV 感染个体出现各种形式的肝病。本研究是一项回顾性队列研究。研究了 907 名 HIV 阳性患者的医疗卡，包括 119 名死亡患者。患者被分为两组：531 名患者对 T. gondii 呈血清阳性，376 名患者呈血清阴性。与血清阴性患者相比，T. gondii 血清阳性患者的一般肝脏病理学更为广泛（分别为 63.1±2.1%和 51.9±2.6%，p<0.001）。在整个队列中（皮尔逊连续性校正系数 C=0.112）和死亡患者中（C=0.228），T. gondii 血清阳性与一般肝脏病理学的关联均较弱。与血清阴性患者相比，T. gondii 血清阳性患者更常合并慢性 HBV-HCV 共感染，无论是在整个队列中（分别为 26.0±1.9%和 18.6±2.0%，p=0.010）还是在死亡患者中（分别为 31.0±5.5%和 14.6±5.1%，p=0.041）。T. gondii 在 HBV-HCV 共感染在队列之间的分布中作用较弱（C=0.187）。在慢性肝炎患者的两个队列中，无论其病因如何，丙氨酸转氨酶（ALT）活性均无显著差异。与整个 T. gondii 血清阳性队列相比，死亡的 T. gondii 血清阳性患者发生肝硬化的几率高 4.5 倍（分别为 23.9±5.1 和 5.3±2.0，p=0.0006），而在 T. gondii 血清阴性队列中并未显著增加（分别为 10.4±4.4 和 4.8±1.1，p>0.05）。T. gondii 在肝硬化形成中的作用较弱（C=0.168）。因此，在 HIV 感染患者中，T. gondii 是一种较弱的非特异性辅助因子，可支持慢性肝脏炎症和肝硬化的进展，而与病因无关，但不影响肝炎活动的程度。在 T. gondii 血清阳性患者中，HBV-HCV 共感染的患病率增加可能与他们与不受控制的血液接触相关的风险因素行为有关。
