This study analyzed liver parameters in HIV patients with and without hepatitis B or C coinfection in India. The study found: 1) A total of 444 HIV patient records were reviewed, with 13 patients coinfected with hepatitis B and 8 with hepatitis C. 2) Liver enzyme levels (AST, ALT, ALP) were measured in pre-ART and ART patients, with and without viral hepatitis coinfection. 3) No statistically significant differences were found in AST or ALT levels between hepatitis B/HIV and hepatitis C/HIV coinfected groups. 4) The study concluded that viral hepatitis coinfection did not significantly impact liver outcomes due to HIV/antiretrovirals or vice versa.

1. Comparison of liver parameters in pre-ART and ART clients with
Viral Hepatitis coinfection in a resource constrained setting in India
N. Mohanty, V. S. Prasad, C. Sarath
AIDS Healthcare Foundation
Results (contd.)
Background
Human immunodeficiency virus (HIV) and Hepatitis B
virus (HBV) and Hepatitis C Virus (HCV) share similar
routes of transmission. Co-infection with the two viruses
has been reported to occur in HIV infected patients,
depending on the prevailing risk factors for acquiring
infection in a given population. In resource constrained
settings the triple parameters of AST, ALT and ALP in
the Liver function test are the most affordable and
accessible tests to guide treatment modifications for
Hepatitis-HIV co-infection. Previous studies have
shown a variable (2-11%)
HBV and HCV
seroprevalence in India. Knowledge of effect of ART on
these liver parameters could provide better guidance on
treatment modification in resource constrained settings.
Comparison of Liver parameters among all 3 groups
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Materials and Methods
Control
PreART
HBV
PreART
AST
ALT
HCV
PreART
Control
PostART
HBV
PostART
HCV Post
ART
ALP
Using the case sheets of all clients of AHF’s clinic in
Delhi, which has been providing HIV treatment and care
for the past 5 years, a retrospective analysis was
conducted to determine the prevalence of HBV and
HCV co-infections among people living with HIV.
Pre ART group of HCV clients showed AST
87.5±29.8, ALT 102.25±60.93, ALP 98.5±34.67 and
ART group had AST 114.5±82.44, ALT 86.5±61.87,
ALP 163.25±63.09.
Rapid Immunochromatographic antibody tests from
Biostandard diagnostics were used for screening of
HBV and HCV co-infection.
The AST parameter in pre-ART clients showed faintly
significant difference between control and HBV as well
as HCV coinfected groups( p= 0.08 and 0.07
respectively, 0.1>p>0.05).
A total of 444 case sheets were reviewed of which
Hepatitis B co-infections were seen in 13 and Hepatitis
C coinfection was seen in 8 cases. 10 case sheets each
for Pre ART and ART control were selected randomly
from the remaining cohort.
Results
All Hepatitis coinfected clients had a mean age of 29.5
±7.11. 68% of HBV co-infections were in the age
group of 31-40 and 38% of all HCV co-infections were
in the age group of 21-30.
Pre-ART group for HBV client showed AST
76.67±60.79, ALT 87±64.60, ALP 109.67±55.61 and
ART group showed AST 50.16±25.62, ALT
72.16±58.14, ALP 95.83±50.48.
References
1.
Sud A, Singh J, Dhiman RK, Wanchu A, Singh S, Chawla Y. Hepatitis B
virus co-infection in HIV infected patients. Trop Gastroenterol. 2001;
22(2):90-2.
No statistically significant difference in AST and ALT
values was seen between the HBV/HIV and HCV/HIV
coinfected arms but the HCV arm had significantly
higher values than the pre-ART control arm in the ALT
group.
The ALP parameter showed faintly significant higher
values in HCV coinfected patients in comparison to
HBV coinfected patients in the ART group (p= 0.06,
0.1>p>0.05).
Conclusions
Viral Hepatitis coinfection did not show any
significant effect on the hepatic outcome due to HIV
and/or antiretrovirals and vice versa. HBV and HCV
coinfections do not have a significantly different
hepatic outcome from each other. A study with a larger
sample size looking at effect of specific antiretrovirals
especially tenofovir and lamivudine on the coinfection
is recommended