title: Causes of liver disease and its outcome in HIV-infected individuals.
abstract: Liver disease in HIV-infected patients has remained unaddressed in India. This study describes the causes of liver disease in HIV-infected patients and short-term outcome in them. Designed as a prospective observational study, it was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research between September 2011 and March 2013. All consecutive HIV patients (>13 years) attending the antiretroviral therapy clinic or admitted in the Medicine Department were screened, and patients with liver disease or with either HBsAg or anti-HCV antibody positivity were included in the study. Of the 198 patients screened, 51 (26 %) had either abnormal liver function test or had HBsAg or anti-HCV positivity. The median age of the patients was 40 years and 82 % were males. The median CD4 count was 123 cells/mm(3). Eighteen (35 %) of them had alcoholic liver disease. Six patients had probable hepatic involvement due to tuberculosis. Ten patients had antituberculosis drug-induced hepatotoxicity. One patient had acute hepatitis B and seven patients had chronic hepatitis B. The cause could not be established in 10 patients (20 %). After a median period of 8 months of follow up, 23 patients had improved, 19 patients (37 %) had died, and six patients had been lost to follow up. Of the patients who had died, 11 patients (58 %) had tuberculosis, and 6 patients (30 %) had decompensated alcoholic liver disease. In conclusion, liver disease in HIV-infected patients was associated with high mortality. Alcohol abuse, tuberculosis, and antituberculosis drugs were the major causes.
authors.affiliation: Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605 006, India. sujukumi@gmail.com.
authors.forename: Suryanarayana Bettadpura
authors.initials: SB
authors.lastname: Shamanna
authors.affiliation: Department of Medicine, Sri Venkateshwara Medical College, Tirupati, Chittoor, 517 520, India.
authors.forename: Ramavath Raghu Ramulu
authors.initials: RR
authors.lastname: Naik
authors.affiliation: Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605 006, India.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Hamide
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D000995:Antitubercular Agents / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014376:Tuberculosis / Q000150:complications
chemical_list: D000995:Antitubercular Agents
keywords: HIV; Liver disease; Outcome; Resource limited