Characteristics of chronic HBV-infection in HIV-infected

Abstract

Objective: to evaluate the course of hepatitis B in HIV-infected patients and the effectiveness of standard therapy for such patients, to establish the features of the formation of liver fibrosis, to determine the prevalence of present, transmitted or "hidden" HBV infection markers, as well as the incidence of concomitant hepatitis D (GD) in patients for HIV infection.Material and methods. The course of chronic hepatitis B (HGV) is analyzed in 100 people: 50 patients — diagnosed with HBV-monoinfection (1st group) and the same number with HGV and concomitant HIV infection (2nd group). Hepatitis B and D screening, clinical and biochemical studies, established the degree of liver fibrosis using the METAVIR score. In addition, in order to determine the prevalence of current, delayed or "hidden" HBV markers in HIV-infected patients, medical records of 114 patients were analyzed.Results. HGV on the background of HIV infection is more frequent than with HBV-monoinfection accompanied by clinical manifestations of astenovegetative dyspeptic syndromes and hepatosplenomegaly, as well as the tendency to a more significant syndrome of cytolysis. In this case of HIV infection HBV HBV is higher than in patients with only HGV. In 6.7% of the patients with HIV, HBV DNA was detected along with the markers of the transmitted HBV infection without the simultaneous detection of HBsAg, which may indicate the presence of "hidden" hepatitis B. Therefore, even with the detection of anti-HVsor, anti-HBe and and a negative result of the HBsAg study, it is advisable to examine the patient for HBV genetic material using PCR. ART according to the tenofovir dizoproxil + emtricitabine + efavirenz scheme, is effective in case of concomitant HGV, because after 6–9 months it provides a reduction in the level of replication of the DNA of NVB up to its disappearance, HBeAg seroconversion, HBsAg sero-reversion, and in 4 of 27 patients, the appearance of anti-HBs. In 4.0% of patients with COPD with HIV infection co-infected or superinfected HDV, accompanied by high cytolysis in the absence of jaundice. Conclusions. Significant influence on the degree of liver fibrosis with concomitant HIV infection has a level of immunodeficiency — the smaller the number of CD4 + -T‑lymphocytes, the deeper the fibrosis and vice versa. There is a strong reverse correlation between the number of CD4 + -T‑lymphocytes in patients with COPD in HIV-infected patients and the degree of hepatic fibrosis according to the METAVIR score (r = – 0.77–0.89, p <0.001).