title: Liver Function Tests Abnormalities and Hepatitis B Virus & Hepatitis C Virus Co-infection in Human Immunodeficiency Virus (HIV)-infected Patients in India.
abstract: BACKGROUND
  While highly active anti-retroviral therapy (HAART) has improved survival of HIV-infected patients, there is increasing liver disease and progressive Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) related liver disease.
  
  
  OBJECTIVE
  To study the liver function tests (LFT) and HBV and HCV co-infection in HIV-infected patients.
  
  
  METHODS
  All HIV-positive patients presenting to a tertiary level hospital from April 2009 to April 2011 were evaluated. Baseline LFT, CD4/CD8 counts, ultrasound abdomen, HBsAg, IgG anti-HBc, HBVDNA, Anti-HCV and HCVRNA were done in all patients. LFT was repeated monthly or more frequently with anti-tubercular therapy (ATT)/HAART.
  
  
  RESULTS
  Abnormal LFT were seen in 143/320 (44.6%) HIV-infected patients (n= 320; M-282, F-38; mean age-35.4 ± 7.3 years). Baseline LFT was abnormal in 48 (15%) [hepatotropic viruses-19, alcohol-24, NAFLD-1, disseminated TB-1, idiopathic-03). Subsequent LFT derangement developed in 95/272 (34.9%). In the majority, the LFT abnormality was mild (119/143-83.2%) and multi-factorial [HAART 132 (76.4%), alcohol 69 (48.2%), ATT 31 (21.7%), HBV 16 (11.2%), HCV 15 (10.4%)]. Using multivariate analysis, abnormal LFT were associated with HAART (OR, 5.92; 95%CI, 2.83-12.37), ATT (OR, 2.06; 95%CI, 1.06-3.99) or HCV infection (OR, 2.54; 95%CI, 1.03-6.26). Significant hepatotoxicity requiring drug modification was seen in only 7 cases. HBV, HCV and HBV + HCV co-infection were seen in 37 (11.6%), 28 (8.8%) and 2 (0.6%) respectively. Occult co-infections were rare [HBV-1 (0.3%); HCV-3 (0.9%)].
  
  
  CONCLUSIONS
  While LFT abnormalities in HIV are common, they are usually mild and multifactorial. HBV and HCV co-infections were seen in 11.6% and 8.8%, respectively. Occult HBV and HCV infections were rare.
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: P
authors.initials: P
authors.lastname: Puri
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Army Hospital (R&R), New Delhi 110010, India.
authors.forename: A
authors.initials: A
authors.lastname: Lolusare
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Sashindran
authors.affiliation: Department of Gastroenterology, Command Hospital, Udhampur, India.
authors.forename: S
authors.initials: S
authors.lastname: Shrivastava
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Nagpal
keywords: ATT; HAART; HIV infection; LFT abnormalities; viral hepatitis