title: Haemodynamic derangement in human immunodeficiency virus-infected patients with hepatitis C virus-related cirrhosis: the role of bacterial translocation.
abstract: OBJECTIVE
  Analysis of the influence of the effects of increased intestinal permeability on haemodynamic alterations in human immunodeficiency virus (HIV)-infected patients with decompensated hepatitis C virus (HCV)-related liver disease.
  
  
  METHODS
  Forty HIV/HCV co-infected patients and 40 HCV mono-infected patients, 20 of them with compensated cirrhosis and 20 with a previous decompensation, and 20 healthy controls, were studied. Intestinal permeability was determined by serum levels of lipopolysaccharide-binding protein (LBP). Monocyte expression of toll-like receptor 4 (TLR-4), serum levels of interleukin (IL)-6 and soluble receptors of tumour necrosis factor (sTNFRI) were analysed. Cardiac index, systemic vascular resistance (SVR), plasma renin activity (PRA) and aldosterone concentration were also determined in cirrhotic patients.
  
  
  RESULTS
  Serum levels of LBP, TLR-4, IL-6 and sTNFRI were significantly higher in HIV-HCV co-infected and HCV mono-infected patients with decompensated cirrhosis compared with those with compensated liver disease. Significantly lower values of SVR and higher values of cardiac index, PRA and aldosterone concentration were observed in patients with decompensated cirrhosis compared with those with compensated liver disease, particularly in those with elevated levels of IL-6. There were no significant differences between HIV/HCV co-infected and HCV mono-infected patients.
  
  
  CONCLUSIONS
  Higher intestinal permeability and consequent macrophage activation is observed in patients with cirrhosis; this permeability is even higher in those with portal hypertension. Serum values of IL-6 are associated with the characteristic haemodynamic derangement observed in advanced phases of cirrhosis. HIV/HCV co-infected cirrhotic patients present inflammatory and systemic haemodynamic alterations similar to those observed in HCV mono-infected patients.
authors.affiliation: Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Monserrat
authors.initials: M
authors.lastname: Montes-de-Oca
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Blanco
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marquez
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Soto
authors.forename: Clotilde
authors.initials: C
authors.lastname: Fernandez-Gutiérrez
authors.forename: Claudio
authors.initials: C
authors.lastname: Rodriguez-Ramos
authors.forename: Jose A
authors.initials: JA
authors.lastname: Giron-Gonzalez
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000704:Analysis of Variance; D018988:Bacterial Translocation; D002352:Carrier Proteins / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D019446:Endotoxemia / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology*; D006439:Hemodynamics; D006526:Hepatitis C / Q000150:complications / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology / Q000821:virology; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007422:Intestines / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology* / Q000821:virology; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D010539:Permeability; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System; D013030:Spain; D051197:Toll-Like Receptor 4 / Q000097:blood; D014655:Vascular Resistance; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D000450:Aldosterone; D002352:Carrier Proteins; D018836:Inflammation Mediators; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D018124:Receptors, Tumor Necrosis Factor; D012083:Renin; D051197:Toll-Like Receptor 4; D000099231:Lipopolysaccharide-Binding Protein; C508600:IL6 protein, human; C495345:TLR4 protein, human