Incidence of and risk factors for liver damage in patients with HIV-1 mono-infection receiving antiretroviral therapy

Evolution of Hematobiochemical Profiles in Newly Diagnosed HIV Patients and HIV-TB Co-Infected Patients: Correlation with Immunological and Virological Status

Background

CD4+ cells, HIV-1 plasma viral load (PVL), and IFN-γ have been observed to enhance susceptibility in TB infection/reactivation among HIV-1 infected people, leading to unusual clinical manifestations. HIV-TB co-infection is significant for immunological and virological response, making it a great clinical challenge for patient management. The objective of this study was to explore the correlation among various hematological and biochemical profiles with CD4+ count and PVL in order to decipher mechanisms of TB development or reactivation in HIV-infected patients.

Methods

In this cross-sectional study, we included 200 newly diagnosed treatment naïve HIV-1 infected patients, of which 118 were HIV-TB co-infected and 82 were HIV-alone. The CD4+ T count was determined using the BD FACS Count System, and the plasma HIV-1 viral load was estimated using the Abbott m2000 real-time platform. The hematobiochemical testing was performed on fully-automated analyzer ADVIA® 560 and Cobas® 501 Roche Diagnostics. Statistical software SPSS-2, Spearman correlation analysis was used for data analysis and a P-value less than 0.05 was considered statistically significant.

Results

Declined hemoglobulin level positively correlated with CD4 counts (r = 0.229; p = 0.001), and a negative correlation was observed with HIV-1 plasma viral load (r = -0.171; p = 0.016). Moreover, the CD4+ count and HIV-1 plasma viral load (PVL) were also correlated to anomalies such as thrombocytopenia, leucopenia, eosinophils, neutrophils, ESR, potassium, Albumin, globulin, SGOT, uric acid. Studies also found significantly higher absolute neutrophil count, ESR, and serum fasting blood sugar, creatine, uric acid, total bilirubin, globulin, and alkaline phosphatase in HIV-TB co-infected patients.

Conclusion and Recommendation

The initial value of Hb, ESR, absolute neutrophil counts, serum calcium, uric acid, and potassium can be used as an early indicator for active tuberculosis (TB) and as a substitute marker for the course of HIV disease, especially in areas with low resources.

CD4/CD8 Ratio Recovered as a Predictor of Decreased Liver Damage in Adults Infected With HIV: 16-Year Observational Cohort Study

BACKGROUND

As the life expectancy of individuals infected with HIV continues to increase, vigilant monitoring of non-AIDS-related events becomes imperative, particularly those pertaining to liver diseases. In comparison to the general population, patients infected with HIV experience a higher frequency of liver-related deaths. The CD4/CD8 ratio is emerging as a potential biomarker for non-AIDS-related events. However, few existing studies have been specially designed to explore the relationship between the CD4/CD8 ratio and specific types of non-AIDS-related events, notably liver damage.

OBJECTIVE

This study aimed to investigate the potential association between the CD4/CD8 ratio and the development of liver damage in a sizable cohort of patients infected with HIV receiving antiretroviral treatment (ART). Additionally, the study sought to assess the effectiveness of 3 antiretroviral drugs in recovering the CD4/CD8 ratio and reducing the occurrence of liver damage in this population.

METHODS

We conducted an observational cohort study among adults infected with HIV receiving ART from 2004 to 2020 in Guangxi, China. Propensity score matching, multivariable Cox proportional hazard, and Fine-Gray competing risk regression models were used to determine the relationship between the CD4/CD8 ratio recovered and liver damage.

RESULTS

The incidence of liver damage was 20.12% among 2440 eligible individuals during a median follow-up period of 4 person-years. Patients whose CD4/CD8 ratio did not recover to 1.0 exhibited a higher incidence of liver damage compared to patients with a CD4/CD8 ratio recovered (adjusted hazard ratio 7.90, 95% CI 4.39-14.21; P<.001; subdistribution hazard ratio 6.80, 95% CI 3.83-12.11; P<.001), findings consistent with the propensity score matching analysis (adjusted hazard ratio 6.94, 95% CI 3.41-14.12; P<.001; subdistribution hazard ratio 5.67, 95% CI 2.74-11.73; P<.001). The Efavirenz-based regimen exhibited the shortest time for CD4/CD8 ratio recovery (median 71, IQR 49-88 months) and demonstrated a lower prevalence of liver damage (4.18/100 person-years).

CONCLUSIONS

Recovery of the CD4/CD8 ratio was associated with a decreased risk of liver damage in patients infected with HIV receiving ART, adding evidence for considering the CD4/CD8 ratio as a potential marker for identifying individuals at risk of non-AIDS-related diseases. An efavirenz-based regimen emerged as a recommended choice for recovering the CD4/CD8 ratio and mitigating the risk of liver damage.

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

OBJECTIVE

This study aimed to build and validate a nomogram model to predict the risk of incomplete immune reconstitution in people living with HIV (PLWH).

METHODS

Totally 3783 individuals with a confirmed diagnosis of HIV/AIDS were included. A predictive model was developed based on a retrospective set (N = 2678) and was validated using the remaining cases (N = 1105). Univariate and multivariate logistic regression analyses were performed to determine valuable predictors among the collected clinical and laboratory variables. The predictive model is presented in the form of a nomogram, which is internally and externally validated with two independent datasets. The discrimination of nomograms was assessed by calculating the area under the curve (AUC). Besides, calibration curve and decision curve (DCA) analyses were performed in the training and validation sets.

RESULTS

The final model comprised 5 predictors, including baseline CD4, age at ART initiation, BMI, HZ and TBIL. The AUC of the nomogram model was 0.902, 0.926, 0.851 in the training cohort, internal validation and external cohorts. The calibration accuracy and diagnostic performance were satisfactory in both the training and validation sets.

CONCLUSIONS

This predictive model based on a retrospective study was externally validated using 5 readily available clinical indicators. It showed high performance in predicting the risk of incomplete immune reconstitution in people living with HIV.