Published: 2017-01-04

Highly active antiretroviral therapy and changing spectrum of liver diseases in HIV infected patients

Kavita S. Joshi, Rohit R. Shriwastav


Background: HIV is now considered as chronic disease than a fatal disease. HIV infected individual is having normal life expectancy post highly active antiretroviral therapy (HAART) era. Liver disease is the major cause of morbidity and mortality in HIV infected patients. The objective was to study the prevalence, clinical profile of various liver diseases in HIV infected individuals on HAART and also to study aetiologies of liver involvement in HIV patients.

Methods: It was a cross sectional observational study conducted from August 2014 to July 2015. 102 HIV positive individuals on HAART with liver involvement were included. Detailed history and clinical examination were noted. Baseline investigations (Hb, CBC, blood sugars, liver function tests, electrocardiogram, chest X-ray, urine routine and microscopy), special investigations (HBsAg, anti-HCV, CD4 count, ultrasonography, CT scan, ascitic fluid examination) were performed. The data was analyzed using descriptive statistics. Results are expressed as percentage.

Results: Out of the total 102 patients, 78 (76.5%) patients were male and 24 (23.5%) patients were female. The maximum number of patients belonged to the age group 41-50 years (38.2%). Hepatitis B (30.8%) was most common liver disease in males and AKT induced hepatitis (41.7%) most common liver disease in females. The most presenting symptom of patients with liver involvement in HIV was weakness and fatigue 82 (80.39%). The most common clinical sign was icterus 39 (38.23%), sonography finding was coarse echotexture of liver (46.07%) suggestive of cirrhosis.

Conclusions: Although hepatitis B and alcoholic liver disease are major causes of liver diseases in HIV patients in India, incidence of drug related hepato toxicities are increasing.



HIV, HAART, Liver disease

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Ocama P, Katwere M, Piloya T, Feld J, Opio KC, Kambugu A. The Spectrum of liver diseases in HIV infected individuals at an HIV treatment clinic in Kampala, Uganda, Afr Health Sci. 2008;8(1):8-12.

Rathi PM, Amrapurkar DN, Borges NE. Spectrum of liver diseases in HIV infection. Indian J Gastroenterology. 1997;16:94-5.

Bonacini M. Hepatobiliary complications in persons with acquired immunodeficiency virus infection. Am J Med. 1992;92(4):404-11.

Marion GP and vincent soriano, HIV and the liver. In Sherlock’s Diseases of the Liver and Biliary system. 12th edition. Wiley Blackwill;2011:438-448.

Fauci AS, Clifford HL. Human immune deficiency virus disease: AIDS and related disorders. Harrison’s Principles of Internal Medicine. 2012;18:1506-85.

Bonacini M, Puoti M. Hepatitis C in patients with Human Immunodeficiency virus infection. Diagnosis, natural history, meta-analysis of sexual and vertical transmission and therapeutic issues. Arch Inern Med. 2000;160:3365-73.

Housset C, Boucher O, Gilard P, Immuno histochemical evidence for human immunodeficiency virus-1 infection of liver kupffer cells. Human Pathol. 1990;21:404-8.

Lafon ME, Kirn A. Human immunodeficiency virus infection in liver. Semin Liver Diseases. 1992;12(2):197-204.

NACO Annual Report 2012-13. Available at Accessed on 18 March 2016.

Rai RR, Mathur A, Mathur D, Udawat HP, Nepalia S, Nijhawan S, et al. Prevalence of occult hepatitis B and C in HIV patients infected through sexual transmission. Trop Gastroenterol. 2007;28(1):19-23.

Nsanzimana S, Remera E, Kanters S, Chan K, Forrest JI, Ford N, et al. Life expectancy among HIV-positive patients in Rwanda: a retrospective observational cohort study. Lancet Glob Health. 2015;3(3):169-77.

Nishiura T, Watanabe H, Ito M. Ultrasound evaluation of the fibrosis stage in chronic liver disease by the simultaneous use of low and high frequency probes. Br J Radiol. 2005;78(927):189-97.