Bacterial translocation in HIV-infected patients with HCV cirrhosis: implication in hemodynamic alterations and mortality.
OBJECTIVE
Analysis of the influence of portal hypertension on intestinal permeability in HIV-infected patients with hepatitis C virus (HCV)-related cirrhosis and of the prognostic significance of consequent macrophage activation.


METHODS
Twenty HIV-monoinfected patients, 70 patients with HIV-HCV coinfection, 20 of them with compensated and 50 with decompensated cirrhosis, and 20 healthy controls were evaluated for intestinal permeability [measured by lipopolysaccharide-binding protein (LBP) serum levels], macrophage activation [soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and interleukin 6 (IL-6)], and activation of the rennin-angiotensin-aldosterone axis. Patients with decompensated cirrhosis were monitored for a median period of 429 days to analyze the prognostic factors implicated in survival.


RESULTS
Patients with decompensated cirrhosis show increased LBP levels compared with HIV-monoinfected patients. Patients with increased LBP concentration showed elevated soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and IL-6 levels. Twenty-two patients died, from liver-related causes, during the follow-up, and 2 more underwent liver transplantation. Child-Pugh index, CD4 T-cell count, plasma aldosterone and serum IL-6 concentrations independently predicted liver-related mortality.


CONCLUSIONS
Increased intestinal permeability, as measured by serum LBP levels, observed in patients with HIV infection is significantly higher in patients with decompensated liver cirrhosis. Proinflammatory cytokines (IL-6) are prognostic markers of HIV-HCV-coinfected patients with decompensated cirrhosis.
Internal Medicine Department, Hospital Universitario Puerta del Mar, Cádiz, Spain. joseantonio.giron@uca.es
Montserrat Montes
MM
de Oca Arjona
Mercedes
M
Marquez
Maria Jose
MJ
Soto
Claudio
C
Rodriguez-Ramos
Alberto
A
Terron
Antonio
A
Vergara
Ana
A
Arizcorreta
Clotilde
C
Fernandez-Gutierrez
Jose Antonio
JA
Giron-González
D000209:Acute-Phase Proteins; D000328:Adult; D018988:Bacterial Translocation / Q000502:physiology*; D002352:Carrier Proteins / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality / Q000821:virology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality; D015850:Interleukin-6 / Q000097:blood; D007422:Intestines / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D008262:Macrophage Activation; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D010539:Permeability; D011379:Prognosis; D016019:Survival Analysis; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002352:Carrier Proteins; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein; C508600:IL6 protein, human