1
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Price JC, Ma Y, Kuniholm MH, Adimora AA, Fischl M, French AL, Golub ET, Konkle-Parker D, Minkoff H, Ofotokun I, Plankey M, Sharma A, Tien PC. Human Immunodeficiency Virus Is Associated With Elevated FibroScan-Aspartate Aminotransferase (FAST) Score. Clin Infect Dis 2022; 75:2119-2127. [PMID: 35511608 PMCID: PMC10200299 DOI: 10.1093/cid/ciac337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Whether human immunodeficiency virus (HIV) infection is associated with the development of nonalcoholic steatohepatitis (NASH) remains unclear. The FibroScan-aspartate aminotransferase (FAST) score was developed to identify patients who have histologic NASH with high nonalcoholic fatty liver disease activity score (NAS ≥4) and significant liver fibrosis (≥F2), which has been associated with higher risk of end-stage liver disease. We examined whether HIV infection is associated with elevated FAST score in a large United States (US) cohort. METHODS Vibration-controlled transient elastography was performed in 1309 women without history of chronic viral hepatitis enrolled from 10 US sites: 928 women with HIV (WWH) and 381 women without HIV (WWOH). We used multivariable logistic regression to evaluate associations of HIV, demographic, lifestyle, and metabolic factors with an elevated (>0.35) FAST score. RESULTS Median age of WWH and WWOH was 51 years and 48 years, respectively. Most (90%) WWH were on antiretroviral therapy and 72% had undetectable HIV RNA. Prevalence of elevated FAST score was higher among WWH compared to WWOH (6.3% vs 1.8%, respectively; P = .001). On multivariable analysis, HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), and greater waist circumference (per 10 cm) was associated with 1.7-fold higher odds (P < .001). In analysis limited to WWH, undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score. CONCLUSIONS Our findings suggest that HIV is an independent risk factor for NASH with significant activity and fibrosis. Studies validating FAST score in persons with HIV are warranted.
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Grants
- U01 AI031834 NIAID NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- R01 DA044111 NIDA NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 DK109823 NIDDK NIH HHS
- U01 AI103390 NIAID NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146245 NHLBI NIH HHS
- K24 AI108516 NIAID NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Women’s Interagency HIV Study
- Multicenter AIDS Cohort Study
- WIHS Combined Cohort Study
- Atlanta Clinical Research Site
- Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood
- Baltimore CRS (Todd Brown and Joseph Margolick)
- Bronx CRS (Kathryn Anastos and Anjali Sharma)
- Brooklyn CRS (Deborah Gustafson and Tracey Wilson)
- Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange, and Elizabeth Golub)
- Chicago–Cook County CRS (Mardge Cohen and Audrey French)
- Chicago-Northwestern CRS (Steven Wolinsky)
- Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien)
- Los Angeles CRS (Roger Detels and Matthew Mimiaga)
- Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein)
- Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones)
- Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo)
- University of Alabama at Birmingham
- University of North Carolina CRS (Adaora Adimora)
- National Heart, Lung, and Blood Institute
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute on Aging
- National Institute of Dental and Craniofacial Research
- National Institute of Allergy and Infectious Diseases
- National Institute of Neurological Disorders and Stroke
- National Institute of Mental Health
- National Institute on Drug Abuse
- National Institute of Nursing Research
- National Cancer Institute
- National Institute on Alcohol Abuse and Alcoholism
- National Institute on Deafness and Other Communication Disorders
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute on Minority Health and Health Disparities
- University of California, San Francisco
- Clinical and Translational Science Award
- Johns Hopkins University, Institute for Clinical and Translational Research
- University of California, Los Angeles, Clinical and Translational Science Institute
- Atlanta, Center for AIDS Research
- Miami CFAR
- University of North Carolina CFAR
- University of Alabama at Birmingham CFAR
- Miami, Center for HIV and Research in Mental Health
- NIAID
- NIDDK
- American College of Gastroenterology Junior Faculty Development Award
- NIH
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Affiliation(s)
- Jennifer C Price
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs, San Francisco, California, USA
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2
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Wekesa C, Ocama P, Parkes-Ratanshi R, Kirk GD. Burden and correlates of significant liver fibrosis among HIV-infected and uninfected adults in urban Uganda. Dialogues Health 2022; 1:100027. [PMID: 38515903 PMCID: PMC10953957 DOI: 10.1016/j.dialog.2022.100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 03/23/2024]
Abstract
Introduction Following chronic inflammation and other disease specific factors, the risk of liver disease is believed to be higher among HIV-infected patients than in the general population despite shared risk factors. Understanding this differentiated burden and its drivers will inform policy and priority populations for intervention. Methods This was a cross sectional study among 516 adults attending care clinics in Kampala Uganda. Significant liver fibrosis (SLF) was defined as liver stiffness measurement ≥7.2 KPa identified by Fibroscan®. Data analyses were stratified by HIV status and we performed logistic regression performed to identify correlates. Results The prevalence of SLF was higher among HIV un-infected patients ((24% Vs 14%; p0.004). Overall HIV-uninfected patients were more likely to be overweight and or obese, with elevated serum cholesterol levels. Elevated measurement of fatty change in the liver (CAP scores >248 dB/m) was associated with SLF among HIV un-infected patients (OR 2.3 CI (1.0-5.2); p = 0.046). Low nadir CD4 counts (200cell/mm3) was predictive of SLF among HIV-infected patients (OR 3.3 CI (1.0-10.7); p = 0.05). Conclusion The prevalence of SLF was unexpectedly higher among HIV un-infected than HIV affected patients attending care clinics in urban Uganda. This observed burden is most likely driven by non-alcoholic fatty liver disease (NAFLD) resulting from metabolic syndrome.
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Affiliation(s)
- Clara Wekesa
- Infectious Diseases Institute, Makerere University Kampala, Uganda
| | - Ponsiano Ocama
- Makerere University, College of Health Sciences Kampala, Uganda
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3
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Zaongo SD, Ouyang J, Chen Y, Jiao YM, Wu H, Chen Y. HIV Infection Predisposes to Increased Chances of HBV Infection: Current Understanding of the Mechanisms Favoring HBV Infection at Each Clinical Stage of HIV Infection. Front Immunol 2022; 13:853346. [PMID: 35432307 PMCID: PMC9010668 DOI: 10.3389/fimmu.2022.853346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Human immunodeficiency virus (HIV) selectively targets and destroys the infection-fighting CD4+ T-lymphocytes of the human immune system, and has a life cycle that encompasses binding to certain cells, fusion to that cell, reverse transcription of its genome, integration of its genome into the host cell DNA, replication of the HIV genome, assembly of the HIV virion, and budding and subsequent release of free HIV virions. Once a host is infected with HIV, the host’s ability to competently orchestrate effective and efficient immune responses against various microorganisms, such as viral infections, is significantly disrupted. Without modern antiretroviral therapy (ART), HIV is likely to gradually destroy the cellular immune system, and thus the initial HIV infection will inexorably evolve into acquired immunodeficiency syndrome (AIDS). Generally, HIV infection in a patient has an acute phase, a chronic phase, and an AIDS phase. During these three clinical stages, patients are found with relatively specific levels of viral RNA, develop rather distinctive immune conditions, and display unique clinical manifestations. Convergent research evidence has shown that hepatitis B virus (HBV) co-infection, a common cause of chronic liver disease, is fairly common in HIV-infected individuals. HBV invasion of the liver can be facilitated by HIV infection at each clinical stage of the infection due to a number of contributing factors, including having identical transmission routes, immunological suppression, gut microbiota dysbiosis, poor vaccination immune response to hepatitis B immunization, and drug hepatotoxicity. However, there remains a paucity of research investigation which critically describes the influence of the different HIV clinical stages and their consequences which tend to favor HBV entrenchment in the liver. Herein, we review advances in the understanding of the mechanisms favoring HBV infection at each clinical stage of HIV infection, thus paving the way toward development of potential strategies to reduce the prevalence of HBV co-infection in the HIV-infected population.
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Affiliation(s)
- Silvere D. Zaongo
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Yaling Chen
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Yan-Mei Jiao
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hao Wu
- Department of Infectious Diseases, You’an Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
- *Correspondence: Yaokai Chen,
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4
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Cheng Z, Lin P, Cheng N. HBV/HIV Coinfection: Impact on the Development and Clinical Treatment of Liver Diseases. Front Med (Lausanne) 2021; 8:713981. [PMID: 34676223 PMCID: PMC8524435 DOI: 10.3389/fmed.2021.713981] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a common contributor to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Approximately 10% of people with human immunodeficiency virus (HIV) also have chronic HBV co-infection, owing to shared transmission routes. HIV/HBV coinfection accelerates the progression of chronic HBV to cirrhosis, end-stage liver disease, or hepatocellular carcinoma compared to chronic HBV mono-infection. HBV/HIV coinfection alters the natural history of hepatitis B and renders the antiviral treatment more complex. In this report, we conducted a critical review on the epidemiology, natural history, and pathogenesis of liver diseases related to HBV/HIV coinfection. We summarized the novel therapeutic options for these coinfected patients.
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Affiliation(s)
- Zhimeng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Lin
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
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5
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Gouvêa ADFTB, Filho RC, Machado DM, Bononi do Carmo F, Beltrão SV, Sampaio L, de Moraes-Pinto MI, Succi RCDM. Assessment of liver disease by non-invasive methods in perinatally infected Brazilian adolescents and young adults living with Human Immunodeficiency Virus (HIV). Braz J Infect Dis 2021; 25:101589. [PMID: 34147474 PMCID: PMC9392177 DOI: 10.1016/j.bjid.2021.101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/30/2021] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Effective and long-term combined antiretroviral therapy (cART) has decreased morbidity and mortality in HIV-infected individuals. Despite treatment advances, HIV-infected children continue to develop noninfectious conditions, including liver fibrosis. METHODS Cross-sectional study designed to identify liver fibrosis in HIV-infected adolescents and young adults, in an outpatients clinic of Pediatric Infectious Diseases Division at Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), diagnosed by noninvasive methods (liver elastography-FibroScan®, APRI and FIB4). Variables examined included demographics, clinical, laboratories, HIV treatment. All participants underwent FibroScan® to measure liver parenchyma elasticity. Values equal to above 7.0 kPa were interpreted as the presence of significant liver fibrosis. Two different biomarkers of liver fibrosis were employed: the AST-to-Platelet Ratio Index (APRI) and the Fibrosis-4 score (FIB-4). APRI values above 1.5 have been considered as levels of clinically significant liver fibrosis and FIB-4 values above 3.25 suggested the presence of advanced fibrosis. RESULTS Between August 2014 and March 2017, the study enrolled 97 patients, age 10-27 years old, fourteen of 97 subjects (14.4%) presented liver stiffness (≥7 kPa) detected by the liver elastography. No patient had APRI> 1.5. No patient had FIB4 value > 3.25. The only isolated laboratory parameter that could be significantly associated with high liver stiffness was thrombocytopenia (p = 0.022, Fisher's exact test). CONCLUSION Liver stiffness was identified in 14.4% (14/97) of this cohort by liver elastography. Liver disease in HIV-infected adolescents and young adults manifests itself silently, so should be routinely investigated.
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Affiliation(s)
- Aida de Fátima Thomé Barbosa Gouvêa
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
| | - Roberto Carvalho Filho
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Hepatology Branch of the Division of Gastroenterology, São Paulo, SP, Brazil
| | - Daisy Maria Machado
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
| | - Fabiana Bononi do Carmo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
| | - Suenia Vasconcelos Beltrão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
| | - Laurene Sampaio
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
| | - Maria Isabel de Moraes-Pinto
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
| | - Regina Célia de Menezes Succi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil
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6
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Hashempour T, Moayedi J, Mousavi Z, Esmaeli M, Asadzadeh A, Hasanshahi Z, Dehghani B. Incidence of Hepatotoxicity in Iranian Patients With HIV on Antiretroviral Therapies and Its Correlation with Virologic Response to HIV Treatment. Lab Med 2020; 52:369-374. [PMID: 33345285 DOI: 10.1093/labmed/lmaa106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To investigate hepatotoxicity in Iranian patients with HIV to assess the association between virologic response to HIV treatment and serum alanine aminotransferase (ALT). METHODS This study was conducted with 200 control patients, 75 patients with HIV naïve to antiretroviral therapy (ART), and 443 patients who received ARTs with virologic response (≤1000 copies/mL) or virologic treatment failure (>1000 copies/mL). Serum ALT level and HIV viral load were determined in all patients. RESULTS Patient ALT levels were significantly higher than those of control patients (45.1 ± 44.4 IU/L vs 23.8 ± 5.4 IU/L). Compared to patients who were ART-naïve, patients with ART experience had significantly higher ALT levels (38.2 ± 26.2 IU/L vs 46.3 ± 46.7 IU/L), and severe hepatotoxicity was only detected in those with ART experience (8 patients, 1.8%). Mean ALT had no significant difference between virologic response/failure groups. The ALT activity and HIV load had a negative correlation coefficient, but it was not significant. CONCLUSION Periodic monitoring for the possibility of hepatotoxicity is highly recommended in all patients with HIV, especially in those receiving ART treatment.
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Affiliation(s)
- Tayebeh Hashempour
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Moayedi
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Mousavi
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Esmaeli
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Biology, Faculty of Science, Nour Danesh Institute of Higher Education, Isfahan, Iran
| | - Azizeh Asadzadeh
- Department of Biology, Faculty of Science, Nour Danesh Institute of Higher Education, Isfahan, Iran
| | - Zahra Hasanshahi
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Dehghani
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Nel JS, Conradie F, Botha J, Etheredge H, Fabian J, Levin L, Mazanderani AH, Moorhouse M, Muller E, Tiemessen C, Thomson D, Turner J. Southern African HIV Clinicians Society guidelines for solid organ transplantation in human immunodeficiency virus: An evidence-based framework for human immunodeficiency virus-positive donors and recipients. South Afr J HIV Med 2020; 21:1133. [PMID: 33240537 PMCID: PMC7670031 DOI: 10.4102/sajhivmed.v21i1.1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeremy S Nel
- Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesca Conradie
- Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Helen Joseph Hospital, Johannesburg, South Africa
| | - Jean Botha
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - June Fabian
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa.,Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Leon Levin
- Helen Joseph Hospital, Johannesburg, South Africa.,Right to Care, NGO, Johannesburg, South Africa
| | - Ahmad H Mazanderani
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Elmi Muller
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Caroline Tiemessen
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,DST/NRF Chair of HIV Vaccine Translational Research, Pretoria, South Africa
| | - David Thomson
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
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8
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Wekesa C, Kirk GD, Aizire J, Benson EM, Karabarinde A, Parkes-Ratanshi R, Ocama P. Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda. Open Forum Infect Dis 2020; 7:ofaa483. [PMID: 33241065 PMCID: PMC7676506 DOI: 10.1093/ofid/ofaa483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. Methods This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. Results Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. Conclusions Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.
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Affiliation(s)
- Clara Wekesa
- MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research, Entebbe, Uganda.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Gregory D Kirk
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Jim Aizire
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Eve-Marie Benson
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Alex Karabarinde
- MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research, Entebbe, Uganda
| | | | - Ponsiano Ocama
- HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda.,Makerere University, College of Health Sciences, Kampala, Uganda
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9
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O'Hara G, Mokaya J, Hau JP, Downs LO, McNaughton AL, Karabarinde A, Asiki G, Seeley J, Matthews PC, Newton R. Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors. BMJ Open 2020; 10:e032890. [PMID: 32234740 PMCID: PMC7170602 DOI: 10.1136/bmjopen-2019-032890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population. DESIGN We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). SETTING We studied a population cohort in South-Western Uganda. PARTICIPANTS Data were available for 8099 adults (median age 30 years; 56% female). RESULTS The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption. CONCLUSIONS Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
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Affiliation(s)
- Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jolynne Mokaya
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
| | - Jeffrey P Hau
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Louise O Downs
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Alex Karabarinde
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippa C Matthews
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR BRC, John Radcliffe Hospital, Oxford, UK
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
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10
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Dagur RS, Wang W, Makarov E, Sun Y, Poluektova LY. Establishment of the Dual Humanized TK-NOG Mouse Model for HIV-associated Liver Pathogenesis. J Vis Exp 2019. [PMID: 31566621 DOI: 10.3791/58645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite the increased life expectancy of patients infected with human immunodeficiency virus-1 (HIV-1), liver disease has emerged as a common cause of their morbidity. The liver immunopathology caused by HIV-1 remains elusive. Small xenograft animal models with human hepatocytes and human immune system can recapitulate the human biology of the disease's pathogenesis. Herein, a protocol is described to establish a dual humanized mouse model through human hepatocytes and CD34+ hematopoietic stem/progenitor cells (HSPCs) transplantation, to study liver immunopathology as observed in HIV-infected patients. To achieve dual reconstitution, male TK-NOG (NOD.Cg-Prkdcscid Il2rgtm1Sug Tg(Alb-TK)7-2/ShiJic) mice are intraperitoneally injected with ganciclovir (GCV) doses to eliminate mouse transgenic liver cells, and with treosulfan for nonmyeloablative conditioning, both of which facilitate human hepatocyte (HEP) engraftment and human immune system (HIS) development. Human albumin (ALB) levels are evaluated for liver engraftment, and the presence of human immune cells in blood detected by flow cytometry confirms the establishment of human immune system. The model developed using the protocol described here resembles multiple components of liver damage from HIV-1 infection. Its establishment could prove to be essential for studies of hepatitis virus co-infection and for the evaluation of antiviral and antiretroviral drugs.
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Affiliation(s)
- Raghubendra Singh Dagur
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center;
| | - Weimin Wang
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center
| | - Edward Makarov
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center
| | - Yimin Sun
- Department of Pathology and Microbiology, University of Nebraska Medical Center
| | - Larisa Y Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center
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11
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Abstract
: Elevation of liver transaminases is common in patients infected with the HIV. Although this is usually an incidental finding during regular work-up, HIV-infected patients with transaminase elevations require additional visits for laboratory studies and clinical assessments, and often undergo interruptions and changes in antiretroviral therapy (ART). Alanine aminotransferase is present primarily in the liver, thus being a surrogate marker of hepatocellular injury. Aspartate aminotransferase is present in the liver and other organs, namely cardiac and skeletal muscle, kidney and brain. Serum levels of both liver transaminases predict liver-related mortality. Moreover, serum fibrosis biomarkers based on alanine aminotransferase and aspartate aminotransferase predict all-cause mortality. In a busy clinical setting, a diagnostic approach to elevated liver transaminases could be complicated given the frequency and nonspecificity of this finding. Indeed, HIV-infected individuals present multiple risk factors for liver damage and chronic elevation of transaminases, including coinfection with hepatitis B and C viruses, alcohol abuse, hepatotoxicity due to ART, HIV itself and frequent metabolic comorbidities leading to nonalcoholic fatty liver disease. This review provides an update on epidemiology of elevated liver transaminases, summarizes the main etiologic contributors and discusses the prognostic significance and a pragmatic approach to this frequent finding in the clinical practice of HIV medicine. With the aging of the HIV-infected population following the successful implementation of ART in Western countries, liver-related conditions are now a major comorbidity in this setting. As such, clinicians should be aware of the frequency, clinical significance and diagnostic approach to elevated liver transaminases.
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12
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Coronel-Castillo CE, Qi X, Contreras-Carmona J, Ramírez-Pérez OL, Méndez-Sánchez N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in HIV infection: a metabolic approach of an infectious disease. Expert Rev Gastroenterol Hepatol 2019; 13:531-540. [PMID: 30905208 DOI: 10.1080/17474124.2019.1599284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the successes of antiretroviral therapy, patients infected with human immunodeficiency virus (HIV) living longer. Regarding this, the common diseases of HIV population (i.e., opportunistic infections) are now losing ground in front of metabolic alterations. This phenomenon is related to the delay in progression to acquired immune deficiency syndrome (AIDS), making it so that patients live in a chronic inflammatory state which, combined with other mechanisms such infectious ones, cause metabolic diseases. Areas covered: Considering a high prevalence of metabolic alterations, the relationship between metabolic syndrome (MetS) with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), and liver diseases as a major cause of death in the HIV-infected population, this paper aims to overview the mechanisms and prevalence of NAFLD and NASH as they relate to the developed metabolic diseases of HIV patients. Expert opinion: The pathways underlying MetS include the effects of HIV and ART on the liver, adipose tissue, and muscle. These mechanisms result in liver damage, consequently leading to NAFLD and its more severe form NASH. These conditions have increased in HIV-infected population in recent years and since their life expectancy is improving it is important to be ready to attend their new emerging diseases.
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Affiliation(s)
| | - Xingshun Qi
- b Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
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13
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Abstract
Liver disease in human immunodeficiency virus (HIV) remains a main cause of morbidity and mortality. Liver-related morbidity and mortality can be caused by multiple etiologic factors, including opportunistic infections, direct and indirect effects of antiretrovirals, direct and indirect effects of HIV, and viral hepatitides. These factors present with varied liver pathophysiologic mechanisms that lead to abnormalities in liver enzymes and synthetic function test, followed by distinct clinical presentations. This article elucidates the direct effects on HIV in the liver and explores the diagnostic and management challenges in patients with HIV in the era of highly active antiretroviral treatment.
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Affiliation(s)
- Katerina G Oikonomou
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA.
| | - Eugenia Tsai
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
| | - Dost Sarpel
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
| | - Douglas T Dieterich
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
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14
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Ganesan M, Poluektova LY, Kharbanda KK, Osna NA. Liver as a target of human immunodeficiency virus infection. World J Gastroenterol 2018; 24:4728-4737. [PMID: 30479460 PMCID: PMC6235802 DOI: 10.3748/wjg.v24.i42.4728] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/10/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Liver injury is a characteristic feature of human immunodeficiency virus (HIV) infection, which is the second most common cause of mortality in HIV-infected patients. Now it is recognized that liver plays a key role in HIV infection pathogenesis. Antiretroviral therapy (ART), which suppresses HIV infection in permissive immune cells, is less effective in hepatocytes, thereby making these cells a silent reservoir of HIV infection. In addition to direct hepatotoxic effects of HIV, certain ART treatment modalities provide hepatotoxic effects. The exact mechanisms of HIV-triggered chronic hepatitis progression are not elucidated, but the liver is adversely affected by HIV-infection and liver cells are prominently involved in HIV-elicited injury. These effects are potentiated by second hits like alcohol. Here, we will focus on the incidence of HIV, clinical evidence of HIV-related liver damage, interactions between HIV and liver cells and the role of alcohol and co-infection with hepatotropic viruses in liver inflammation and fibrosis progression.
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Affiliation(s)
- Murali Ganesan
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68105, United States
| | - Larisa Y Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Kusum K Kharbanda
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68105, United States
| | - Natalia A Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68105, United States
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15
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Botha J, Conradie F, Etheredge H, Fabian J, Duncan M, Haeri Mazanderani A, Paximadis M, Maher H, Britz R, Loveland J, Ströbele B, Rambarran S, Mahomed A, Terblanche A, Beretta M, Brannigan L, Pienaar M, Archibald-Durham L, Lang A, Tiemessen CT. Living donor liver transplant from an HIV-positive mother to her HIV-negative child: opening up new therapeutic options. AIDS 2018; 32:F13-9. [PMID: 30281558 DOI: 10.1097/QAD.0000000000002000] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life. Design: A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient. Methods: Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing. Results: Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant. Conclusion: This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.
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16
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Ganesan M, Dagur RS, Makarov E, Poluektova LI, Kidambi S, Osna NA. Matrix stiffness regulate apoptotic cell death in HIV-HCV co-infected hepatocytes: Importance for liver fibrosis progression. Biochem Biophys Res Commun 2018; 500:717-722. [PMID: 29679566 PMCID: PMC6863049 DOI: 10.1016/j.bbrc.2018.04.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
HIV-HCV co-infection causes rapid progression of liver fibrosis. These outcomes to liver cirrhosis can be improved, but not stopped by specific antiviral therapies. Due to high significance of HIV-HCV interactions for morbidity and mortality in co-infected patients, our attention was attracted to the multi-component pathogenesis of fibrosis progression as the transition to end-stage liver disease development. In this study, we hypothesize that increased matrix stiffness enhances apoptosis in HCV-HIV-co-infected hepatocytes and that capturing of apoptotic bodies (AB) derived from these infected hepatocytes by hepatic stellate cells (HSC) drives the fibrosis progression. As the source of viruses, JFH1 (HCV genotype 2a) and HIV-1ADA (either purified or containing in infected macrophage supernatants) were chosen. Using Huh7.5-CYP (RLW) cells and primary human hepatocytes mono-infected with HCV and HIV or co-infected, we have shown that both HCV and HIV RNA levels were increased in co-infected cells, which was accompanied by hepatocyte apoptosis. This apoptosis was attenuated by azidothymidine treatment. The levels of both infections and apoptosis were more prominent in primary hepatocytes cultured on substrates mimicking fibrotic stiffness (24 kPa-stiff) compared to substrates mimicking healthy liver (2.4 kPa-soft). The engulfment of AB from pathogen-exposed hepatocytes activated pro-fibrotic mRNAs in HSC. Overall, the increased matrix stiffness is not only a consequence of liver inflammation/fibrosis, but the condition that further accelerates liver fibrosis development. This is attributed to the switching of HSC to pro-fibrotic phenotype by capturing of excessive amounts of apoptotic HCV- and HIV-infected hepatocytes.
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Affiliation(s)
- Murali Ganesan
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Raghubendra Singh Dagur
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edward Makarov
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Larisa I Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Srivatsan Kidambi
- Department of Chemical and Biomolecular Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Natalia A Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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17
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Nampala H, Luboobi LS, Mugisha JYT, Obua C, Jablonska-Sabuka M. Modelling hepatotoxicity and antiretroviral therapeutic effect in HIV/HBV coinfection. Math Biosci 2018; 302:67-79. [PMID: 29800563 DOI: 10.1016/j.mbs.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 01/08/2023]
Abstract
Enzyme alanine aminotransferase (ALT) elevation which reflects hepatocellular injury is a current challenge in people infected with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). One of the factors that enhance the risk of hepatotoxicity is underlying diseases such as hepatitis caused by hepatitis B virus (HBV). HIV/HBV coinfected patients stand a greater risk of hepatotoxicity because all ART are toxic and liver cells (hepatocytes) that are responsible for metabolising the toxic ART, support all stages of HIV and HBV viral production. Mathematical models coupled with numerical simulations are used in this study with the aim of investigating the optimal combination of ART in HIV/HBV coinfection. Emtricitabine, tenofovir and efavirenz is the optimal combination that maximises the therapeutic effect of therapy and minimises the toxic response to medication in HIV/HBV coinfection.
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Affiliation(s)
- Hasifa Nampala
- Department of Mathematics, Kyambogo University, P.O Box 1, Kampala, Uganda.
| | | | - Joseph Y T Mugisha
- Department of Mathematics, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, P.O Box 7062, Uganda
| | - Matylda Jablonska-Sabuka
- Department of Computational Engineering and Physics, Lappeenranta University of Technology, Finland
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18
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Mere SM, Paruk S. A chart review of human immunodeficiency virus status in patients admitted with psychosis in Durban, South Africa. S Afr J Psychiatr 2018; 24:1129. [PMID: 30263214 PMCID: PMC6138071 DOI: 10.4102/sajpsychiatry.v24i0.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/05/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Comorbid human immunodeficiency virus (HIV) infection among patients with psychotic disorders is associated with a poorer outcome. Understanding the association of HIV infection with demographic and clinical variables may provide clues to modify risk factors and outcomes. AIM To describe and compare the socio-demographic and clinical profile of patients admitted with psychotic disorders with and without HIV infection. METHOD A retrospective chart review of 100 adult patients consecutively admitted with psychosis and HIV infection and compared to 101 patients with psychosis without HIV infection. RESULTS HIV-infected patients with psychotic disorders were more likely to be females (74.0%), younger than 50 years (94.0%) and less likely to have secondary education than HIV- negative patients with psychotic disorders (56.0% vs. 72.0%). HIV-infected patients were also less likely to be diagnosed as having schizophrenia (33.0%), had higher rates of medical (73.0%) and psychiatric (21.0%) comorbid disorders and were less likely to report lifetime nicotine and cannabis use (p = 0.047 and p = 0.011). HIV-negative patients with psychotic disorders were more likely to be readmitted to the unit in the next 12 months (p < 0.05). HIV-infected patients with psychotic disorders had increased abnormal haematological results (33.0%). CONCLUSION Patients with psychotic disorders and HIV infection had several negative prognostic factors such as younger age, increased rates of medical and psychiatric comorbidity, abnormal haematological results and longer length of admission periods. This suggests the need to target HIV prevention programmes at young females with mental illness and provide an integrated healthcare service with medical and psychiatric assessment and care for patients with HIV and psychosis.
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Affiliation(s)
- Sellwane M Mere
- Department of Psychiatry, University of KwaZulu-Natal, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, University of KwaZulu-Natal, South Africa
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19
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Xu L, Zhu B, Huang Y, Yang Z, Sun J, Xu Y, Zheng J, Kinloch S, Yin MT, Weng H, Wu N. Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients. Mediators Inflamm 2018; 2018:5201652. [PMID: 29736152 DOI: 10.1155/2018/5201652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 01/24/2018] [Indexed: 11/17/2022] Open
Abstract
Background Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients. Methods BChE levels (in U/L) were measured in 505 patients; <4500 was defined as “low” and ≥4500 as “normal.” Associations between BChE level and CD4 count, WHO stage, body mass index (BMI), C-reactive protein (CRP) level, and duration of hospitalization were assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters. Results A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (all P < 0.001). Eighty-four patients (16.6%) died in the first year of follow-up. One-year survival was 64.5 ± 4.5% for patients with low BChE and 87.6 ± 1.8% for those with normal BChE (log-rank, P < 0.001). After adjustment for sex, age, BMI, WHO stage, and CD4 count, as well as serum levels of hemoglobin, sodium, and albumin, the hazard ratio was 1.8 (95% confidence interval, 1.0–3.2) for patients with a low BChE compared with those with a normal BChE (P = 0.035). Conclusion BChE level is associated with HIV/AIDS severity and is an independent risk factor for increased mortality in AIDS patients.
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20
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Dagur RS, Wang W, Cheng Y, Makarov E, Ganesan M, Suemizu H, Gebhart CL, Gorantla S, Osna N, Poluektova LY. Human hepatocyte depletion in the presence of HIV-1 infection in dual reconstituted humanized mice. Biol Open 2018; 7:bio029785. [PMID: 29361613 PMCID: PMC5861361 DOI: 10.1242/bio.029785] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/09/2018] [Indexed: 02/05/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection impairs liver function, and liver diseases have become a leading cause of morbidity in infected patients. The immunopathology of liver damage caused by HIV-1 remains unclear. We used chimeric mice dually reconstituted with a human immune system and hepatocytes to address the relevance of the model to pathobiology questions related to human hepatocyte survival in the presence of systemic infection. TK-NOG males were transplanted with mismatched human hematopoietic stem/progenitor cells and hepatocytes, human albumin concentration and the presence of human immune cells in blood were monitored for hepatocytes and immune reconstitution, and mice were infected with HIV-1. HIV-1-infected animals showed a decline in human albumin concentration with a significant reduction in percentage of human hepatocytes compared to uninfected mice. The decrease in human albumin levels correlated with a decline in CD4+ cells in the liver and with an increase in HIV-1 viral load. HIV-1 infection elicited proinflammatory response in the immunological milieu of the liver in HIV-infected mice compared to uninfected animals, as determined by upregulation of IL23, CXCL10 and multiple toll-like receptor expression. The inflammatory reaction associated with HIV-1 infection in vivo could contribute to the depletion and dysfunction of hepatocytes. The dual reconstituted TK-NOG mouse model is a feasible platform to investigate hepatocyte-related HIV-1 immunopathogenesis.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Raghubendra Singh Dagur
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Weimin Wang
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Yan Cheng
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Edward Makarov
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Murali Ganesan
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68198, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Hiroshi Suemizu
- Laboratory Animal Research Department, Central Institute for Experimental Animals, 3-25-12 Tonomachi, Kawasaki, Kawasaki 210-0821, Japan
| | - Catherine L Gebhart
- Molecular Diagnostics Laboratory, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Santhi Gorantla
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Natalia Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68198, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Larisa Y Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
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21
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Fisher BS, Green RR, Brown RR, Wood MP, Hensley-McBain T, Fisher C, Chang J, Miller AD, Bosche WJ, Lifson JD, Mavigner M, Miller CJ, Gale M, Silvestri G, Chahroudi A, Klatt NR, Sodora DL. Liver macrophage-associated inflammation correlates with SIV burden and is substantially reduced following cART. PLoS Pathog 2018; 14:e1006871. [PMID: 29466439 PMCID: PMC5837102 DOI: 10.1371/journal.ppat.1006871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/05/2018] [Accepted: 01/09/2018] [Indexed: 12/19/2022] Open
Abstract
Liver disease is a leading contributor to morbidity and mortality during HIV infection, despite the use of combination antiretroviral therapy (cART). The precise mechanisms of liver disease during HIV infection are poorly understood partially due to the difficulty in obtaining human liver samples as well as the presence of confounding factors (e.g. hepatitis co-infection, alcohol use). Utilizing the simian immunodeficiency virus (SIV) macaque model, a controlled study was conducted to evaluate the factors associated with liver inflammation and the impact of cART. We observed an increase in hepatic macrophages during untreated SIV infection that was associated with a number of inflammatory and fibrosis mediators (TNFα, CCL3, TGFβ). Moreover, an upregulation in the macrophage chemoattractant factor CCL2 was detected in the livers of SIV-infected macaques that coincided with an increase in the number of activated CD16+ monocyte/macrophages and T cells expressing the cognate receptor CCR2. Expression of Mac387 on monocyte/macrophages further indicated that these cells recently migrated to the liver. The hepatic macrophage and T cell levels strongly correlated with liver SIV DNA levels, and were not associated with the levels of 16S bacterial DNA. Utilizing in situ hybridization, SIV-infected cells were found primarily within portal triads, and were identified as T cells. Microarray analysis identified a strong antiviral transcriptomic signature in the liver during SIV infection. In contrast, macaques treated with cART exhibited lower levels of liver macrophages and had a substantial, but not complete, reduction in their inflammatory profile. In addition, residual SIV DNA and bacteria 16S DNA were detected in the livers during cART, implicating the liver as a site on-going immune activation during antiretroviral therapy. These findings provide mechanistic insights regarding how SIV infection promotes liver inflammation through macrophage recruitment, with implications for in HIV-infected individuals.
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Affiliation(s)
- Bridget S. Fisher
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Richard R. Green
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Rachel R. Brown
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Matthew P. Wood
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Tiffany Hensley-McBain
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Cole Fisher
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Jean Chang
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Andrew D. Miller
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Section of Anatomic Pathology, Ithaca, New York, United States of America
| | - William J. Bosche
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Jeffrey D. Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Maud Mavigner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Charlene J. Miller
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, United States of America
| | - Guido Silvestri
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Emory Vaccine Research Center and, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
| | - Ann Chahroudi
- Emory Vaccine Research Center and, Yerkes National Primate Research Center, Atlanta, Georgia, United States of America
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States of America
| | - Nichole R. Klatt
- Department of Pharmaceutics, Washington National Primate Research Center, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Sodora
- Center for Infectious Disease Research, formally Seattle Biomedical Research Institute, Seattle, Washington, United States of America
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Saracino A, Cozzi-Lepri A, Shanyinde M, Ceccherini Silberstein F, Nozza S, Di Biagio A, Cassola G, Bruno G, Capobianchi M, Puoti M, Monno L, d’Arminio Monforte A. HIV-1 co-receptor tropism and liver fibrosis in HIV-infected patients. PLoS One 2018; 13:e0190302. [PMID: 29324755 PMCID: PMC5764264 DOI: 10.1371/journal.pone.0190302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/12/2017] [Indexed: 01/18/2023] Open
Abstract
Background In vitro, gp120 of both X4 and R5 HIV-1 strains activates human hepatic stellate cells, but if it can promote liver fibrosis in vivo is unknown. We aimed to evaluate if patients carrying X4 or R5 strains have a different liver fibrosis (LF) progression over time. Methods A total of 1,137 HIV-infected patients in ICONA cohort (21% females, 7% HCV co-infected) with an available determination of HIV-1 co-receptor tropism (CRT), a Fibrosis-4 Index for Liver Fibrosis (FIB-4) <3.25 and at least one-year follow-up were included. CRT was assessed by gp120 sequencing on plasma RNA and geno2pheno algorithm (10% false positive rate) or by Trofile. LF was assessed by means of FIB-4. LF progression was defined as an absolute score increase or a transition to higher fibrosis stratum and/or occurrence of liver-related clinical events. Results A total of 249 (22%) patients carried X4 strains, which were associated with older age, lower CD4 count, lower nadir CD4, and intravenous drug use. Overall, X4 and R5 patients had similar baseline FIB-4 scores and similar mean FIB-4 slope after a median follow-up of 35 months. There was no difference between X4 and R5 for time to LF progression (p = 0.925). Estimated risk of LF at 24 months (95% CI) after baseline in X4 and R5 was 10.6% (8.3–12.9) and 9.9% (5.9–14.0), respectively. Age, HCV co-infection, diabetes, HIV-duration, HIV-RNA>100.000 cp/mL, antiretroviral therapy exposure were associated with LF progression at multivariate analysis. Conclusions A slight LF progression over time was observed in HIV-infected patients. No difference was demonstrated for X4 and R5 HIV-1 strains in accelerating LF evolution.
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Affiliation(s)
- Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
- * E-mail:
| | - Alessandro Cozzi-Lepri
- Department of Infection and Population Health, University College London Medical School, Royal Free Campus, London, United Kingdom
| | - Milensu Shanyinde
- Department of Infection and Population Health, University College London Medical School, Royal Free Campus, London, United Kingdom
| | | | - Silvia Nozza
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Di Biagio
- Infectious Diseases Department, IRCCS San Martino Hospital, Genoa, Italy
| | - Giovanni Cassola
- Division of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Giuseppe Bruno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Maria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, AO Niguarda Ca' Granda, Milan, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Antonella d’Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo H, University of Milan, Milan, Italy
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Chupradit K, Moonmuang S, Nangola S, Kitidee K, Yasamut U, Mougel M, Tayapiwatana C. Current Peptide and Protein Candidates Challenging HIV Therapy beyond the Vaccine Era. Viruses 2017; 9:E281. [PMID: 28961190 DOI: 10.3390/v9100281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/13/2022] Open
Abstract
Human immunodeficiency virus (HIV) is a causative agent of acquired immune deficiency syndrome (AIDS). Highly active antiretroviral therapy (HAART) can slow down the replication of HIV-1, leading to an improvement in the survival of HIV-1-infected patients. However, drug toxicities and poor drug administration has led to the emergence of a drug-resistant strain. HIV-1 immunotherapy has been continuously developed, but antibody therapy and HIV vaccines take time to improve its efficiency and have limitations. HIV-1-specific chimeric antigen receptor (CAR)-based immunotherapy founded on neutralizing antibodies is now being developed. In HIV-1 therapy, anti-HIV chimeric antigen receptors showed promising data in the suppression of HIV-1 replication; however, autologous transfusion is still a problem. This has led to the development of effective peptides and proteins for an alternative HIV-1 treatment. In this paper, we provide a comprehensive review of potent anti-HIV-1 peptides and proteins that reveal promising therapeutic activities. The inhibitory mechanisms of each therapeutic molecule in the different stages of the HIV-1 life cycle will be discussed herein.
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Wei Q, Lin H, Ding Y, Liu X, Wu Q, Shen W, Gao M, He N. Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China. Biosci Trends 2017; 11:274-281. [PMID: 28484111 DOI: 10.5582/bst.2017.01071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We assessed the factors that influenced improvement or progression in human immunodeficiency virus (HIV)-infected patients who were receiving combination antiretroviral therapy (cART). This was a retrospective cohort study of HIV-infected patients receiving cART in Taizhou, Zhejiang, China, 2009-2015. Liver fibrosis was assessed by Fibrosis-4 (FIB-4) score. Improvement of liver fibrosis was defined as having > 30% decrease in FIB-4 from baseline, whereas progression of liver fibrosis was defined as having > 30% increase in FIB-4 score from baseline. A total of 955 HIV-infected patients were included. Of these, 808 (84.6%) were HIV-monoinfection, 125 (13.1%) were HIV/hepatitis B virus (HBV) coinfection and 29 (3.0%) were HIV/hepatitis C virus (HCV) coinfection. The median duration of treatment was 15 months. After treatment, 37.1% participants had > 30% decreases in FIB-4 index, 14.8% had > 30% increases in FIB-4 index, while the remaining 48.2% had stabilized FIB-4 index. In multivariate analysis, improvement of liver fibrosis was negatively associated with an older age, but was positively associated with baseline FIB-4 index and > 30% increases in CD4 cell count after ART. Progression of liver fibrosis was positively associated with an older age, but was negatively associated with gender and HIV transmission mode (male homosexual vs. male heterosexual, female heterosexual vs. male heterosexual), and baseline FIB-4 index. Our findings indicate that improvement of liver fibrosis could be achieved by early initiation of ART through better CD4 cell recovery. Liver fibrosis and hepatotoxicity associated with ART should be monitored as early as possible and throughout till the end of treatment, with special attention to the elderly and heterosexual men.
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Affiliation(s)
- Qian Wei
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education
| | - Qionghai Wu
- Taizhou City Center for Disease Control and Prevention
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University
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Abstract
The advances in management of patients with acquired immunodeficiency syndrome (AIDS) with highly effective anti-retroviral therapy (HAART) have resulted in increased longevity of patients with human immunodeficiency virus (HIV) infection. AIDS-related illnesses now account for less than 50 % of the deaths, and liver diseases have emerged as the leading cause of death in patients with HIV infection. Chronic viral hepatitis, drug-related hepatotoxicity, non-alcoholic fatty liver disease, and opportunistic infections are the common liver diseases that are seen in HIV-infected individuals. Because of the shared routes of transmission, co-infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are very common in HIV-infected persons. Hepatitis C is the most common viral hepatitis seen in HIV-infected patients. With the availability of directly acting agents, treatment outcome of HCV is comparable to that seen in non HIV-infected patients. Careful monitoring is required for drug interactions and drug-induced hepatotoxicity and modification of drugs should be done where necessary. The results of liver transplantation in select HIV-infected patients can be comparable with those of HIV-negative patients.
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26
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Saracino A, Bruno G, Scudeller L, Ladisa N, de Gennaro N, Allegrini M, Monno L, Angarano G. CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR. J Clin Virol 2016; 81:94-9. [PMID: 27371888 DOI: 10.1016/j.jcv.2016.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/10/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND In HIV-HCV co-infected patients, the long-term effects of HCV eradication on HIV disease progression are still unclear. OBJECTIVES This study aims to determine if CD4 and CD4/CD8 ratio slopes improved after anti-HCV treatment in patients achieving a sustained virological response (SVR). STUDY DESIGN A total of 116 HIV-HCV co-infected patients, previously treated with Peg-IFN/RBV, were divided into two groups: SVR (55 patients who had achieved SVR), and non-SVR (61 patients). Retrospective data before and after anti-HCV therapy were obtained for all patients, with a median 8 year-follow-up. Multilevel mixed models were fitted to assess the trends over time of FIB-4 score, APRI score, CD4, CD8 cell count and CD4/CD8 ratio. RESULTS Median HIV-infection duration, HCV-RNA and GGT baseline levels were higher in non-SVR compared to the SVR group. A significantly decreased FIB-4 (p<0.001) and APRI trend (p<0.001) after SVR was observed in SVR patients compared to those non-SVR. After adjustment for HIV duration, there was no significant difference between the two groups for absolute CD4 (p=0.08) or percentage CD4 slope (p=0.6) over time. The CD4/CD8 ratio trend also demonstrated a similar progressive increase in both groups (p=0.2). During follow-up, six deaths were reported in the non-SVR group versus no death for the SVR group, while no difference in AIDS and non-AIDS events was observed. CONCLUSIONS Achievement of SVR determines an important beneficial impact in terms of liver-related mortality and fibrosis regression, but does not seem to alter neither the slope of long term CD4 gain nor the CD4/CD8 ratio evolution in ART-treated HIV-HCV co-infected patients.
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Affiliation(s)
- A Saracino
- Clinic of Infectious Diseases, University of Bari, Italy.
| | - G Bruno
- Clinic of Infectious Diseases, University of Bari, Italy
| | - L Scudeller
- Scientific Direction, Clinical Epidemiology Unit, IRCCS San Matteo Foundation, Pavia, Italy
| | - N Ladisa
- Clinic of Infectious Diseases, University of Bari, Italy
| | - N de Gennaro
- Clinic of Infectious Diseases, University of Bari, Italy
| | - M Allegrini
- Clinic of Infectious Diseases, University of Bari, Italy
| | - L Monno
- Clinic of Infectious Diseases, University of Bari, Italy
| | - G Angarano
- Clinic of Infectious Diseases, University of Bari, Italy
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Del Cornò M, Cappon A, Donninelli G, Varano B, Marra F, Gessani S. HIV-1 gp120 signaling through TLR4 modulates innate immune activation in human macrophages and the biology of hepatic stellate cells. J Leukoc Biol 2016; 100:599-606. [DOI: 10.1189/jlb.4a1215-534r] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/16/2016] [Indexed: 01/10/2023] Open
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Shanyengana LP, Mukesi M, der Colf BEV, Moyo SR. Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/wja.2016.63014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Dusingize JC, Hoover DR, Shi Q, Mutimura E, Rudakemwa E, Ndacyayisenga V, Gakindi L, Mulvihill M, Sinayobye JD, Musabeyezu E, Anastos K. Association of Abnormal Liver Function Parameters with HIV Serostatus and CD4 Count in Antiretroviral-Naive Rwandan Women. AIDS Res Hum Retroviruses 2015; 31:723-30. [PMID: 25924728 PMCID: PMC4505765 DOI: 10.1089/aid.2014.0170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We determined the associations of HIV infection/CD4 count with markers of hepatocellular damage [elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and liver synthetic function (decreased albumin) in HIV-infected (HIV+) antiretroviral therapy (ART)-naive and uninfected (HIV−) Rwandan women. In 2005, 710 HIV+ ART-naive and 226 HIV− women enrolled in the Rwanda Women's Interassociation Study and Assessment. Liver enzymes were measured with abnormality defined as either AST or ALT ≥1.25 times the upper limit of normal. Low serum albumin level was defined as <3.5 g/dl. Multivariable logistic regression analysis identified independent predictors of elevated AST/ALT and low serum albumin. HIV− women had the lowest prevalence (6.6%) of abnormal AST/ALT, with the highest prevalence (16.4%) in HIV+ women with CD4 <200 cells/μl (p=0.01). The odds of having serum albumin <3.5 g/dl was 5.7-fold higher in HIV+ than HIV− women (OR=5.68, 95% CI: 3.32–9.71). The risk of low albumin decreased from low to high CD4 count, with OR=2.62, 95% CI: 1.66, 4.14 and OR=1.57, 95% CI: 1.01, 2.43 in HIV+ women with a CD4 count <200 and 200–350 cells/μl, respectively vs. HIV+ with CD4 >350 (p<0.001 and p<0.05 for all comparisons). Our findings suggest that HIV-associated liver damage may occur in ART-naive patients. Although liver abnormality prevalences in this cohort of HIV-infected Rwandan women are less than reported in developed countries, caution is needed for risk assessment measures to monitor and screen HIV-infected patients pre- and post-ART initiation in African clinical settings to curtail potential risks associated with HIV infection.
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Affiliation(s)
| | | | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, New York, New York
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development (RASD Rwanda), Kigali, Rwanda
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Gouvêa Ade F, Machado DM, Beltrão SC, Carmo FB, Mattar RH, Succi RC. [Noncirrhotic portal hypertension in a human immunodeficiency virus (HIV) infected adolescent]. Rev Paul Pediatr 2015; 33:246-50. [PMID: 25913495 DOI: 10.1016/j.rpped.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/16/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To alert the pediatrician who is following up HIV-infected patients about the possibility of non-cirrhotic portal hypertension (NCPH) in this period of life, in order to avoid the catastrophic consequences of this disease as bleeding esophageal varices. CASE DESCRIPTION A 13 years old HIV-infected patient by vertical route was receiving didanosine (ddI) for 12 years. Although the HIV viral load had been undetectable for 12 years, this patient showed gradual decrease of CD4+ T cells, prolonged thrombocytopenia and high alkaline phosphatase. Physical examination detected splenomegaly, which triggered the investigation that led to the diagnosis of severe liver fibrosis by transient elastography, probably due to hepatic toxicity by prolonged use of ddI. COMMENTS This is the first case of NCPH in HIV-infected adolescent described in Brazil. Although, the NCPH is a rare disease entity in seropositive patients in the pediatric age group, it should be investigated in patients on long-term ddI or presenting clinical and laboratories indicators of portal hypertension, as splenomegaly, thrombocytopenia and increased alkaline phosphatase.
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Castilho JL, Jenkins CA, Shepherd BE, Bebawy SS, Turner M, Sterling TR, Melekhin VV. Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women. J Womens Health (Larchmt) 2015; 24:481-8. [PMID: 25751720 DOI: 10.1089/jwh.2014.5003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population. METHODS We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use. RESULTS Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32-10.4) and mood disorders, specifically (aOR 4.70 [1.87-11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64-4.12 and aOR 1.16, 95% CI 0.86-1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01-2.08). CONCLUSIONS Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs.
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Affiliation(s)
- Jessica L Castilho
- 1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Cathy A Jenkins
- 2 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Bryan E Shepherd
- 2 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Sally S Bebawy
- 1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Megan Turner
- 1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Timothy R Sterling
- 1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee
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Ansari AWW, Schmidt RE, Shankar EM, Kamarulzaman A. Immuno-pathomechanism of liver fibrosis: targeting chemokine CCL2-mediated HIV:HCV nexus. J Transl Med 2014; 12:341. [PMID: 25528160 PMCID: PMC4272802 DOI: 10.1186/s12967-014-0341-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/24/2014] [Indexed: 12/19/2022] Open
Abstract
Even in the era of successful combination antiretroviral therapy (cART), co-infection of Hepatitis C virus (HCV) remains one of the leading causes of non-AIDS-related mortality and morbidity among HIV-positive individuals as a consequence of accelerated liver fibrosis and end-stage liver disease (ESLD). The perturbed liver microenvironment and induction of host pro-inflammatory mediators in response to HIV and HCV infections, play a pivotal role in orchestrating the disease pathogenesis and clinical outcomes. How these viruses communicate each other via chemokine CCL2 and exploit the liver specific cellular environment to exacerbate liver fibrosis in HIV/HCV co-infection setting is a topic of intense discussion. Herein, we provide recent views and insights on potential mechanisms of CCL2 mediated immuno-pathogenesis, and HIV-HCV cross-talk in driving liver inflammation. We believe CCL2 may potentially serve an attractive target of anti-fibrotic intervention against HIV/HCV co-infection associated co-morbidities.
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Affiliation(s)
- A W Wahid Ansari
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Lambah Pantai 50603, Kuala Lumpur, Malaysia.
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Nampala H, Luboobi LS, Mugisha JYT, Obua C. Modelling Hepatotoxicity of Antiretroviral Therapy in the Liver during HIV Monoinfection. ACTA ACUST UNITED AC 2014; 2014:1-17. [DOI: 10.1155/2014/659675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver related complications are currently the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. In HIV monoinfected individuals on therapy, liver injury has been associated with the use of antiretroviral agents as most of them exhibit some degree of toxicity. In this study we proposed a mathematical model with the aim of investigating hepatotoxicity of combinational therapy of antiretroviral drugs. Therapy efficacy and toxicity were incorporated in the model as dose-response functions. With the parameter values used in the study, protease inhibitors-based regimens were found to be more toxic than nonnucleoside reverse transcriptase inhibitors-based regimens. In both regimens, the combination of stavudine and zidovudine was the most toxic baseline nucleoside reverse transcriptase inhibitors followed by didanosine with stavudine. However, the least toxic combinations were zidovudine and lamivudine followed by didanosine and lamivudine. The study proposed that, under the same second line regimens, the most toxic first line combination gives the highest viral load and vice versa.
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Abstract
Liver disease is now a major cause of morbidity and mortality among persons infected with the human immunodeficiency virus (HIV). An increasing body of evidence suggests that HIV infection is associated with exacerbated liver fibrosis and that HIV has the ability to infect several hepatic cell types. Despite the recognized existence of genetically distinct subpopulations of HIV in the central nervous system and genital tract, viral diversity and compartmentalization in the liver have not been explored extensively. Therefore, phylogenetic analysis was performed on full-length env and nef sequences for four patients. Distinct clustering of viral variants was observed for all patients in both areas of the genome. Statistical evidence of HIV compartmentalization in the liver was demonstrated in 85.4% of comparisons. Signature sequence analysis identified several liver-specific amino acids in all patients. Thus, the current study demonstrates statistically significant evidence for HIV compartmentalization in the liver. Additionally, these data suggest that the hepatic microenvironment harbors unique selective pressures that drive viral adaptation.
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Affiliation(s)
- Patricia K. Penton
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jason T. Blackard
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Tahiri M, Sodqi M, Lahdami FEZ, Marih L, Lamdini H, Hliwa W, Lahcen AO, Badre W, Haddad F, Chakib A, Bellabah A, Alaoui R, Filali KME. Risk factors for liver fibrosis among human immunodeficiency virus monoinfected patients using the FIB4 index in Morocco. World J Hepatol 2013; 5:584-588. [PMID: 24179618 PMCID: PMC3812461 DOI: 10.4254/wjh.v5.i10.584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 07/05/2013] [Accepted: 09/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the prevalence and risk factors of significant hepatic fibrosis in Moroccan human immunodeficiency virus (HIV) monoinfected patients.
METHODS: We conducted a cross-sectional study among HIV monoinfected patients (negative for hepatitis B surface antigen and hepatitis C antibody). Clinical and laboratory data were collected from the data base of the Infectious Diseases Unit in Ibn Rochd Hospital Center [age, gender, duration of HIV infection, CD4 T lymphocyte count, HIV viral load, glycemia and current or prior use of antiretroviral and antiretroviral therapy (ART) duration]. The primary outcome was a FIB4 score > 1.45. Multivariable logistic regression identified independent risk factors for FIB4 > 1.45.
RESULTS: A FIB4 score > 1.45 was identified in 96 among 619 (15.5%). HIV monoinfected patients followed up between September 1990 and September 2012. Multivariate analysis showed that only a viral load > 75 (OR = 2.23, 95%CI: 1.36-3.67), CD4 > 200 cells/mm3 (OR = 0.39, 95%CI: 0.21-0.72) and age at FIB4 index calculation (OR = 1.10, 95%CI: 1.07-1.13) were independently associated with the occurrence of FIB4 index (> 1.45). Gender, duration of HIV infection, glycemia, use of antiretroviral therapy and ART duration were not associated with significant fibrosis by FIB4.
CONCLUSION: FIB4 score > 1.45 was found in 15.5% of Moroccan HIV monoinfected patients. Age, HIV viremia > 75 copies/mL and CD4 count > 200 cells/mm3 are associated with liver fibrosis. Further studies are needed to explore mechanisms for fibrosis in HIV monoinfected patients.
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Diwe CK, Okwara EC, Enwere OO, Azike JE, Nwaimo NC. Sero-prevalence of hepatitis B virus and hepatitis C virus among HIV patients in a suburban University Teaching Hospital in South-East Nigeria. Pan Afr Med J 2013; 16:7. [PMID: 24570778 PMCID: PMC3926757 DOI: 10.11604/pamj.2013.16.7.3077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/16/2013] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Highly active antiretroviral therapy (HAART) has improved survival of human immunodeficiency virus (HIV) patients. Concurrent morbidities from liver diseases among these patients have also been observed due to co-infection with hepatitis B and C viruses (HBV and HCV). HAART reduces liver-associated morbidities and mortalities in such patients. Unfortunately free testing of HBV and HCV are not provided alongside free HIV testing and treatment in Nigeria. We assessed the seroprevalence of HBV and HCV among HIV patients presenting for treatment in our center. METHODS This prospective study of adult patients with HIV/AIDS assessed the seroprevalence of HBV and HCV co-infection using a 19-item questionnaire and collection of 2ml venous blood for hepatitis B surface antigens (HBsAg) and anti-HCV antibodies. All previously diagnosed HIV patients of the unit were excluded from the study. RESULTS Of the 404 patients, 69.2% were females while 30.8% were males. Married participants were 59.6%, 25.3% were single and 15% were previously married. A large proportion (69%) of patients were farmers, artisans and traders. Most had some formal education; secondary (55.3%), primary 27.3%, tertiary 13.8%. HBsAg positive participants were 9 (2.2%) while 3 (0.7%) were positive for HCV. No participant had triple infection of HIV/HBV/HCV. CONCLUSION Seroprevalence of HBV and HCV is low among HIV patients in Orlu. However there is a need for HBV and HCV testing of all HIV positive patients to reduce morbidities and mortalities from liver diseases.
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Affiliation(s)
- Chiekulie Kevin Diwe
- Department of Community Medicine, College of Medicine, Imo State University, Orlu Campus, Imo State, Nigeria
| | | | - Oguamanam Okezie Enwere
- Department of Internal Medicine, College of Medicine, Imo State University, Orlu Campus, Imo State, Nigeria
| | - Jerome Emeka Azike
- Department of Surgery, College of Medicine, Imo State University, Orlu Campus, Imo State, Nigeria
| | - Nathan Chibuzo Nwaimo
- Department of Chemical Pathology, Imo State University Teaching Hospital, Orlu, Imo State, Nigeria
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de Almeida FB, Corrêa CL, de Siqueira NG, de Carvalho NVFMDSC, Rodrigues-Silva R, de Andrade AFB, Machado-Silva JR. Histopathological findings of an uncommon co-infection: Echinococcus vogeli, HIV, hepatitis C virus, and hepatitis B virus. Int J Infect Dis 2013; 17:e925-7. [PMID: 23735863 DOI: 10.1016/j.ijid.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 03/07/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022] Open
Abstract
Our work represents the first case report of polycystic echinococcosis co-infection with HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV). Structural liver alterations were found to be related to parasitic structures and necroinflammatory foci (karyopyknosis, karyorrhexis, and karyolysis), consistent with Echinococcus vogeli. Visceral adipose tissue and intrahepatic triglyceride droplets (macrovesicular and microvesicular steatosis) indicated abnormal fat anabolism, which probably resulted from both viral-induced hepatopathy and drug-related toxicity. In summary, our results suggest that the observed liver abnormalities reflected the coincident exposure to hepatotropic viruses and parasites causing polycystic echinococcosis and were not indicative of opportunistic relationships among these pathogens.
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Kew MC. Hepatitis B virus / human immunodeficiency virus co-infection and its hepatocarcinogenic potential in sub-saharan black africans. Hepat Mon 2012; 12:e7876. [PMID: 23166538 PMCID: PMC3500827 DOI: 10.5812/hepatmon.7876] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/28/2012] [Accepted: 08/02/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT Since the introduction of highly active anti-retroviral regimen for human immunodeficiency virus-1 infection, a significant increase in the incidence of hepatocellular carcinoma has been reported in patients already chronically infected with hepatitis B virus and then given this form of regimen for their retroviral infection. EVIDENCE ACQUISITION This phenomenon was initially attributed to the far more prolonged survival of those patients who received this new regimen, which provided sufficient time, allowing hepatitis B virus-induced hepatocellular carcinoma to develop. RESULTS The current belief is that the increased incidence of hepatocellular carcinoma is because of co-infection with the two viruses, one known to be hepatocarcinogenic and the other suspected to increase the carcinogenic potential of the other. Because both hepatitis B virus and human immunodeficiency virus -1 are endemic in the Black population of sub-Saharan Africa and are transmitted in similar ways, as many as 20% of this population are co-infected with the two viruses. In this way, the already high risk of Black African patients developing hepatitis B virus-induced hepatocellular carcinoma is further increased. CONCLUSIONS The pathogenetic mechanism or mechanisms involved in the carcinogenic interaction between the hepatitis B virus and the human immunodeficiency virus-1 in sub-Saharan Black Africans and other populations co-infected with these viruses have yet to be determined.
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Affiliation(s)
- Michael C. Kew
- Department of Medicine, Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Corresponding author: Michael C. Kew, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, and Department of Medicine, Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa. Tel.: +27-217822949, Fax: +27-214486815, E-mail:
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Abstract
Liver diseases are an important and largely neglected health issue in low and middle income countries, which carry the highest burden. In this Topic Highlight, experts review hepatitis B and E, alcoholic liver disease, hepatic diseases in human immunodeficiency virus -infected individuals, hepatocellular carcinoma. Numerous gaps in our knowledge that need to be filled are outlined and feasible solutions to the several problems related to diagnosis and management of liver diseases in developing countries are suggested.
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Affiliation(s)
- Francesca Cainelli
- Francesca Cainelli, School of Medicine, Faculty of Health Sciences, University of Botswana, PO Box 00713, Gaborone, Botswana
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