Abstract
Liver disease in HIV-infected patients may result from the infection itself, antiretroviral treatment or comorbidities. In this study, we analysed liver disease in 79 HIV-infected children and adolescents aged 14.0 ± 5.1 years. All the patients were receiving combination antiretroviral therapy (cART), with a mean duration of 11.5 ± 4.7 years. Six patients (8%) had detectable HIV viral load, and 8/79 (10%) of the participants were coinfected with hepatitis B or C virus (HCV, 6/8 or HBV, 2/8). Liver disease was defined as an elevation of any of the following parameters: alanine or aspartate aminotransferase (ALT and AST), total bilirubin, and gamma glutamyl transferase (GGTP). For the noninvasive evaluation of liver fibrosis, the AST-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) were calculated. Liver disease was diagnosed in 20/79 (25%) of the patients, including 13/71 (18%) of participants without coinfection and 7/8 (88%) with coinfection (p < 0.0001). All of the liver markers except bilirubin were significantly higher in the coinfected group. APRI scores indicated significant fibrosis in 5/8 (63%) of patients with coinfection. HBV or HCV coinfection and detectable HIV viral load were independently positively associated with APRI (p = 0.0001, and p = 0.0001) and FIB-4 (p = 0.001, and p = 0.002, respectively). In conclusion, liver disease in HIV-infected children and adolescents results mainly from HBV or HCV coinfection. Effective antiretroviral treatment is protective against hepatic abnormalities.
Highlights
In the era of combination antiretroviral therapy, the risk of Acquired Immunodeficiency Syndrome (AIDS)-associated morbidities and mortality has decreased significantly and has been replaced by illnesses and deaths resulting from non-AIDS causes[1,2,3]
Concomitant hepatitis B was diagnosed based on positive hepatitis B surface antigen testing, as confirmed by positive hepatitis B virus (HBV) DNA polymerase chain reaction (PCR), whereas hepatitis C diagnosis was made using anti-HCV testing and confirmed by nucleic acid testing - positive HCV RNA real-time PCR
All patients with HIV/HBV and HIV/HCV coinfection were simultaneously infected with both viruses
Summary
In the era of combination antiretroviral therapy (cART), the risk of Acquired Immunodeficiency Syndrome (AIDS)-associated morbidities and mortality has decreased significantly and has been replaced by illnesses and deaths resulting from non-AIDS causes[1,2,3]. According to the limited available data in pediatric patients, hepatitis does not seem to be as common cause of death in HIV-infected children as in adults[3]. Liver disease in HIV-infected patients may result from the infection itself, antiretroviral drug toxicity, or comorbidities, including coinfection with hepatitis B and C viruses (HBV and HCV)[5]. Due to its invasive nature, several noninvasive methods, including two serum biomarkers, Aspartate transaminase to platelet ratio index (APRI), and Fibrosis-4 (FIB-4) have been proposed[15]. Both markers were validated for their ability to detect liver fibrosis in adult patients with viral hepatitis[15]. The available noninvasive biomarkers of liver disease were determined
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