الفهرس 
Acquired Immunodeficiency SyndromeOnly 14 pages are availabe for public view
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Abstract
Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus co-infections is emerging as an increasing cause of morbidity and mortality in HIV infected persons. As hepatitis co-infection with HIV accelerates disease progression in both HCV and HBV and also increases the risk of anti-retroviral drug associated hepatotoxicity. It would appear that the immunological status of mono-infection is higher than HBVIHCV coinfection, as evidenced by the higher CD~+ counts in HIV mono-infected than HIV-co-infected with HBVIHCV. This study was designed to test the prevalence of liver disease as well as the magnitude of burden of HBV and HCV co-infections in HIV patients and their impact on the disease progression. We retrospectively reviewed the records of 115 HIV positive patients admitted to Alexandria Fever Hospital during the period from April 201 1 until the end of the study in September 2012. Among this group of patients, 48 patients had concomitant HBV and/or HCV infections. Thirty of each group received highly active antiretroviral treatment (HAART). This study revealed that HIV infected patients are at a high risk of viral co-infections, as evident from 4 (3.5%) patients had HBV coinfection, 37 (32.2%) patients had HCV coinfection and 7 (6.1%) patients had both HBV and HCV coinfections. Regarding the prevalence of liver disease morbidity among the studied patients: hepatomegaly was present in 55 (47.8%), while shrunken liver was found in 2 1 (1 8.3%). Certainly, the number of patients with shrunken liver was significantly higher in co-infection group(p=0.001). There was high prevalence of NAFLD in HIV patients (35.7%). There was high prevalence of cirrhosis among HIV patients 30.4%). Certainly, cirrhosis was significantly associated with co infection of HIV and hepatitis B and/or C (p=0.03 1). The prevalence of HCC was 1(1.5%) among patients without HBV or HCV co-infection and 2(4.2%) among patients co-infected with HIV and hepatitis viruses. Liver enzymes were significantly higher in HIV patients co-infected with HBV and/or HCV with mean ALT and AST 65.04 * 27.03 and 65.35 * 27.0 respectively compared to HIV monoinfection group (3 8 .O4 * 19.36 and 36.87 * 18.72 respectively) (p<0.00 1). Regarding the effect of HIV treatment (whether Efavirenz + lamizidine or truvada) on liver hnction tests, there was significant impairment of both HIV mono-infected and HIVfiBV, HCV co-infected patients during treatment. However, the impairment was worse in co-infected patients (ALT = 90.41 * 51.15 vs. 63.83 * 26.61 and AST = 89.90 * 51.57 vs. 64.10 * 26.43). CD4’ counts rose significantly in both HIV mono-infection and HIVfiBV, HCV coinfection patients after HAART. However, the CD4’ increase in those not co-infected with HBV or HCV was higher when compared with those of HBV or HCV co-infected with the mean CD4’ (703.57 * 214.04 vs 403.57 * 120.14, p < O.OOl).This suggests that although HAART does improve the immune system of co-infected patients, but its efficiency is relatively compromised by HBV and HCV interactions. In conclusion, liver disease is common among HIV-infected patients. Hepatic morbidity encountered were hepatomegaly, NAFLD, liver cirrhosis and HCC. The prevalence of viral hepatitis (HBV and/or HCV) among HIV positive individuals was high. HIV infection may accelerate progression of liver damage caused by HCV or HBV infection. HAART itself are associated with a potential risk for hepatotoxicity, this risk is even enhanced in patients with hepatitis coinfection.