Liver disease, TB prevalent in South African patients with HIV
Liver disease and tuberculosis were common in a cohort of adult South African patients with HIV, according to data from a retrospective study.
“In settings with a high TB prevalence, TB is an important cause of extra-pulmonary disease,” researcher Christopher J. Hoffmann, MD, assistant professor of medicine at Johns Hopkins University School of Medicine, told Healio.com/Hepatology. “In addition, both TB medications and a paradoxical TB reaction once treatment has been started, can cause liver inflammation and are the most common causes of liver inflammation in a patient being treated for tuberculosis. Unfortunately differentiating the two causes can be difficult, even with liver biopsy results.”
Hoffmann and colleagues analyzed data from 262 adult patients (median age, 34 years) admitted to a regional hospital in the North West province of South Africa between 2001 and 2009. All underwent liver biopsy due to the presence of liver disease, and 41% were HIV-infected, 10% were HIV-seronegative and 49% had unknown HIV status while hospitalized, according to the research.
Forty-four percent of patients with HIV were undergoing antiretroviral therapy, 34% were receiving cotrimoxazole, 44% were receiving treatment for TB and 19% were receiving all three. Three HIV-seronegative patients and two with unknown HIV status were receiving treatment for TB at the time of biopsy.
Of all the biopsies, 81% granted diagnostic data. From the data, researchers found that 41 patients had granuloma; 21 had cholangiopathy; 36 had steatosis; 56 had malignancy; 36 had fibrosis; 45 had a nondiagnostic pattern; six had an inadequate specimen; and 21 had others, according to the research. Twelve of the 36 patients with fibrosis had cirrhosis and 10 liver biopsies showed evidence of drug-induced liver injury, of which eight of these patients had HIV.
Patients with HIV were more likely to have granulomas or TB (26%) compared with HIV-seronegative patients (8%) and patients with unknown status (8.5%; P = .001). Malignancy was a cause of liver disease among the HIV-seronegative patients, according to the research.
“Hepatic steatosis is common in this South African population,” Hoffmann said. “It may indicate a shifting epidemiology of non-communicable diseases or may reflect a known toxicity of a HIV medication (stavudine) which is fortunately now being used less frequently.”
Disclosure: The researchers report no relevant financial disclosures.
Hoffmann CJ, et al. PLoS One. 2015;doi:10.1371/journal.pone.0117813.
Source: Healio
