Impact of HIV co-infection in patients presenting with hepatic hydatid disease

Abstract

Background: HIV and echinococcus granulosis (EG) co-infection, whilst rare globally, still affects communities in Southern Africa and appears to be increasing. In this, the first comparative study between patients with hepatic hydatid disease (HHD) with and without HIV co-infection in the same population, the hypothesis from case studies that co-infection-associated immune modulation may lead to a more severe clinical presentation of HHD was assessed. Material & Methods: Patients presenting at the Surgical Gastroenterology unit, Groote Schuur Hospital, South Africa with HHD between 2012 and 2018, and for whom the HIV status was known, were included. Demographic characteristics, clinical parameters and serological and laboratory tests were compared in patients, with and without HIV co-infection. Results: HIV prevalence in the study population (n=38) was 50%. Females predominated in both groups (16/19 HIV+ and 14/19 HIV-). HIV+ patients tended to be younger (median age 32 vs. 39; p=0.181) with a lower BMI (median 23.6 vs. 25.4; p=0.126). No significant clinical differences were found. Abdominal pain was the most common symptom (15/19 in both groups) and abdominal tenderness the most common clinical finding (9/19 HIV+ and 10/19 HIV- patients). EG serology was positive in only 10/19 HIV+ patients, compared to 16/19 HIV- patients (p<0.060). Laboratory findings were similar, however conjugated bilirubin was more often raised in HIV+ patients (p<0.064). Conclusion: Whilst supporting previous reports of an impaired EG antibody response in HIV+ patients, this study refutes the hypothesis of a more severe clinical presentation. The HIV co-infection rate was higher than the prevalence in the general South African population of 12.6%, indicating that HIV is an important factor in HHD infection. Most patients were controlled on anti-retrovirals, suggesting disease severity might be contained by HIV suppression. Urgent surgery should be dictated by disease severity rather than the presence of HIV co-infection.