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Li Y, Li C, Wang J, Zhu C, Zhu L, Ji F, Liu L, Xu T, Zhang B, Xue L, Yan X, Huang R, Wu C, Yan X. A case series of COVID-19 patients with chronic hepatitis B virus infection. J Med Virol 2020; 92:2785-2791. [PMID: 32558945 PMCID: PMC7323302 DOI: 10.1002/jmv.26201] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
Previous studies reported that coronavirus disease 2019 (COVID-19) was likely to result in liver injury. However, few studies reported the impacts of COVID-19 on liver function in patients with chronic liver diseases. We aimed to describe a case series of COVID-19 patients with chronic hepatitis B virus (HBV) infection. Confirmed hospitalized COVID-19 patients from hospitals in 10 cities of Jiangsu province, China, were retrospectively included between 18 January 2020 and 26 February 2020. Demographic information, epidemiologic data, clinical features, and treatment data were extracted from medical records. Seven COVID-19 patients with chronic HBV infection were included. Six (85.7%) patients were male. The patients aged from 33 to 49 years. Two patients had HBV-related cirrhosis. One patient (14.3%) was positive for serum HBV e-antigen. On admission, 1 (14.3%) patient had mildly elevated alanine aminotransferase (ALT) level (>40 U/L) and 1 (14.3%) had elevated aspartate aminotransferase (AST) level (>40 U/L). The serum albumin level and platelet counts were decreased in two patients with HBV-related liver cirrhosis. Three (42.9%) patients had elevated ALT level and 2 (28.6%) patients had elevated AST level in hospitalization. However, the peak ALT and AST level during hospitalization was 51 U/L and 44 U/L, respectively. As of 29 February 2020, all patients were discharged. No patient was admitted to the intensive care units or developed liver failure during hospitalization. The abnormalities of liver function are not uncommon on COVID-19 patients with chronic HBV infection in our case series. However, no patient developed severe liver-related complications during hospitalization.
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Affiliation(s)
- Yang Li
- Department of Infectious DiseasesTaizhou People's HospitalTaizhouChina
| | - Chunyang Li
- Department of Infectious DiseasesNanjing Medical UniversityNanjingChina
- Department of Infectious DiseaseThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Chuanwu Zhu
- Department of Infectious DiseasesThe Affiliated Infectious Diseases Hospital of Soochow UniversitySuzhouChina
| | - Li Zhu
- Department of Infectious DiseasesThe Affiliated Infectious Diseases Hospital of Soochow UniversitySuzhouChina
| | - Fang Ji
- Department of Infectious DiseaseThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Longgen Liu
- Department of Infectious DiseasesThe Third People's Hospital of ChangzhouChangzhouChina
| | - Tianmin Xu
- Department of Infectious DiseasesThe Third People's Hospital of ChangzhouChangzhouChina
| | - Biao Zhang
- Department of Quality Control OfficeHuai'an No. 4 People's HospitalHuai'anChina
| | - Leyang Xue
- Department of Critical MedicineHuai'an No. 4 People's HospitalHuai'anChina
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Xuebing Yan
- Department of Infectious DiseasesNanjing Medical UniversityNanjingChina
- Department of Infectious DiseaseThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Neukam K, Mira JA, Collado A, Rivero-Juárez A, Monje-Agudo P, Ruiz-Morales J, Ríos MJ, Merino D, Téllez F, Pérez-Camacho I, Gálvez-Contreras MC, Rivero A, Pineda JA. Liver Toxicity of Current Antiretroviral Regimens in HIV-Infected Patients with Chronic Viral Hepatitis in a Real-Life Setting: The HEPAVIR SEG-HEP Cohort. PLoS One 2016; 11:e0148104. [PMID: 26848975 PMCID: PMC4743911 DOI: 10.1371/journal.pone.0148104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/13/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To assess the current frequency of ART-associated grade 3-4 transaminase elevations (TE) and grade 4 total bilirubin elevations (TBE) in HIV-infected patients with chronic hepatitis B and/or C, who start a new regimen of ART. PATIENTS AND METHODS A total of 192 pre-treated or treatment-naive HIV infected patients with HBV and/or HCV-coinfection who started ART in eight Southern Spanish centers from July/2011-December/2013, were followed for 12 months in this prospective study. RESULTS Forty-one (21.4%) subjects had been naïve to ART, median (IQR) follow-up was 11.6 (5.6-12.9) months. The most frequently initiated NRTI were tenofovir/emtricitabine [49 patients (25.5%)]. Eighty-nine (46.4%) patients started a ritonavir-boosted protease inhibitor and 77 (40.1%) individuals a NNRTI. Raltegravir and maraviroc were initiated in 24 (12.5%) and 9 (4.7%) individuals. Ten [5.21%; 95% confidence interval (CI): 2.53%-9.37%] patients presented grade 3 TE, while 8 (4.17%; 95%CI: 1.82%-8.04%) subjects showed grade 4 TBE. No episodes of grade 4 TE or ART discontinuation due to hepatotoxic events were observed. The use of ritonavir-boosted atazanavir was the only independent predictor for grade 4 TBE [adjusted odds ratio: 7.327 (95%CI: 1.417-37.89); p = 0.018] in an analysis adjusted for age, sex and baseline HIV-RNA levels, while no factor could be independently associated with grade 3-4 TE. CONCLUSIONS Currently, the frequency of severe ART-associated TE and TBE under real-life conditions in patients with chronic viral hepatitis is similar to what has been reported previously. However, episodes of grade 4 TE are less frequent and severe TE appears to be of lesser concern.
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Affiliation(s)
- Karin Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - José A. Mira
- Internal Medicine Service, Hospital Universitario de Valme, Seville, Spain
| | - Antonio Collado
- Internal Medicine Department, Hospital Torrecárdenas, Almeria, Spain
| | | | - Patricia Monje-Agudo
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Josefa Ruiz-Morales
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Dolores Merino
- Internal Medicine Service, Hospital Juan Ramón Jiménez. Huelva, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital de La Línea de la Concepción, Cadiz, Spain
| | | | | | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Juan A. Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Sagir A, Glaubach B, Sahin K, Graf D, Erhardt A, Oette M, Häussinger D. Transient Elastography for the Detection of Liver Damage in Patients with HIV. Infect Dis Ther 2015; 4:355-64. [PMID: 26143457 PMCID: PMC4575292 DOI: 10.1007/s40121-015-0073-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction Highly active antiretroviral therapy (HAART) is effective and well tolerated, but hepatotoxicity is relatively common. Different non-invasive methods are available for detecting liver fibrosis in patients with chronic liver disease. Methods Patients who were HIV positive and who had given their informed consent were included in this cross-sectional study. Transient elastography [FibroScan® (FS); Echosens], serum hyaluronic acid (HA), Hepascore (HS), Fibrosis-4 (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) were used to detect liver fibrosis in the patients. The agreement between FS and the other methods was evaluated. To observe the hepatotoxicity of HAART, patients with chronic viral hepatitis B or C were excluded by detection of hepatitis B surface antigens and hepatitis C virus antibodies. Patients with chronic alcohol intake were excluded by measuring carbohydrate-deficient transferrin (CDT). FS correlation with the duration of therapy with protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) was evaluated. Results Overall, 203 patients were included in the study. The agreement between the different tests ranged from 64% to 77%: FS vs. HA, 72%; FS vs. APRI, 74%; FS vs. HS, 77%; and FS vs. FIB-4, 64%. After excluding patients with chronic hepatitis B or C and elevated CDT, 153 patients remained for studying the hepatotoxicity of HAART. A significant correlation of FS with the duration of medication intake was observed for PIs (P = 0.026; r = 0.18). NRTI and NNRTI therapy duration did not correlate with FS. Conclusions The agreement between FS and other tests ranged from 64% to 77%. A significant correlation was found between liver stiffness and the duration of therapy with PIs, which underlines the known hepatotoxicity of this substance group. Funding Heinz-Ansmann Foundation. Electronic supplementary material The online version of this article (doi:10.1007/s40121-015-0073-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdurrahman Sagir
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
- Bethesda Krankenhaus Duisburg, Duisburg, Germany.
| | - Birgit Glaubach
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Kurtulus Sahin
- Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Cologne, Germany
| | - Dirk Graf
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Andreas Erhardt
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Mark Oette
- Augustinerinnen Hospital, Cologne, Germany
| | - Dieter Häussinger
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany
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Meissner EG, Suffredini AF, Kottilil S. Opportunities in proteomics to understand hepatitis C and HIV coinfection. Future Virol 2012; 7:759-765. [PMID: 23105947 PMCID: PMC3480018 DOI: 10.2217/fvl.12.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Antiretroviral therapy has significantly reduced morbidity and mortality associated with HIV infection. However, coinfection with HCV results in a more complicated disease course for both infections. HIV infection dramatically impacts the natural history of chronic liver disease due to HCV. Coinfected patients not on antiretroviral therapy for HIV develop liver fibrosis and cirrhosis at a faster rate, clear acute infection less commonly and respond to IFN-α-based therapy for chronic infection less often than HCV-monoinfected patients. The interaction between these two viruses, the immune system and the fibrotic machinery of the liver remains incompletely understood. In this review, we discuss recent advances in proteomics as applied to HCV and HIV and highlight issues in coinfection that are amenable to further discovery through proteomic approaches. We focus on clinical predictors of liver fibrosis and treatment outcome as these have the greatest potential clinical applicability.
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Affiliation(s)
- Eric G Meissner
- Laboratory of Immunoregulation, National Institute of Allergy & Infectious Diseases, Bethesda, MD 20892, USA
| | - Anthony F Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shyamasundaran Kottilil
- Laboratory of Immunoregulation, National Institute of Allergy & Infectious Diseases, Bethesda, MD 20892, USA
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Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study. J Acquir Immune Defic Syndr 2009; 52:391-6. [DOI: 10.1097/qai.0b013e3181ab73cc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Teicher E, Abbara C, Duclos-Vallée JC, Antonini T, Bonhomme-Faivre L, Desbois D, Samuel D, Vittecoq D. Enfuvirtide: a safe and effective antiretroviral agent for human immunodeficiency virus-infected patients shortly after liver transplantation. Liver Transpl 2009; 15:1336-42. [PMID: 19790146 DOI: 10.1002/lt.21818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate the impact of an enfuvirtide-based antiretroviral (ARV) regimen on the management of immunosuppression and follow-up in hepatitis C virus (HCV)/hepatitis B virus (HBV)/human immunodeficiency virus (HIV)-coinfected liver transplant patients in comparison with a lopinavir/ritonavir-based ARV regimen. Tacrolimus and cyclosporine trough concentrations were determined at a steady state during 3 periods: after liver transplantation without ARV treatment (period 1), at the time of ARV reintroduction (period 2), and 2 to 3 months after liver transplantation (period 3). The findings for 22 HIV-coinfected patients were compared (18 with HCV and 4 with HBV); 11 patients were treated with enfuvirtide and were matched with 11 lopinavir/ritonavir-exposed patients. During period 1, tacrolimus and cyclosporine A doses were 8 and 600 mg/day, respectively, and the trough concentrations were within the therapeutic range in both groups. In period 2, the addition of lopinavir/ritonavir to the immunosuppressant regimen enabled a reduction in the dose of immunosuppressants required to maintain trough concentrations within the therapeutic range (to 0.3 mg/day for tacrolimus and 75 mg/day for cyclosporine). Immunosuppressant doses were not modified by the reintroduction of enfuvirtide, there being no change in the mean trough concentrations over the 3 periods. CD4 cell counts remained at about 200 cells/mm3. The HIV RNA viral load remained undetectable. Both groups displayed signs of mild cytolysis and cholestasis due to the recurrence of HCV, whereas no renal insufficiency was observed. Enfuvirtide is an attractive alternative to standard ARV therapy, facilitating the management of drug-drug interactions shortly after liver transplantation. Moreover, the lack of liver toxicity renders this drug valuable in the event of a severe HCV recurrence.
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Affiliation(s)
- Elina Teicher
- Département Médecine Interne et Infectiologie, AP-HP Hôpital Paul Brousse, Villejuif, France.
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Mendes-Correa MC, Widman A, Brussi MLP, Guastini CF, Gianini RJ. Incidence and predictors of severe liver fibrosis in HIV-infected patients with chronic hepatitis C in Brazil. AIDS Patient Care STDS 2008; 22:701-7. [PMID: 18752463 DOI: 10.1089/apc.2007.0216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (F3-F4) by multivariate analysis were age (older patients) and genotype 3 (genotype 1 = odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as, HCV genotype 3. No differences were found with respect to CD4(+) T cell counts although patients with a CD4(+) T cell count greater than 50 were excluded.
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Affiliation(s)
- Maria Cássia Mendes-Correa
- Casa da AIDS, Division of Infectious Diseases, Hospital das Clinicas, University of Säo Paulo, São Paulo, Brazil
| | - Azzo Widman
- Digestive Surgery Division, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Maria Luiza Paes Brussi
- Casa da AIDS, Division of Infectious Diseases, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Cristina Fátima Guastini
- Casa da AIDS, Division of Infectious Diseases, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Reinaldo José Gianini
- Laboratory of Medical Investigation in Epidemiology and Statistics, Medical School, University of São Paulo, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW To summarize the pertinent literature on the causes, epidemiology, prevalence, clinical features, evaluation and mechanisms of drug-induced liver injury reported during 2007. RECENT FINDINGS Although the frequency of drug-induced liver injury remains low, new data from the Centers for Disease Control and Prevention confirm that of the approximately 1600 new acute liver failure cases annually, acetaminophen hepatotoxicity accounts for 41%; among children with acute liver failure, acetaminophen was the second most common cause. Antimicrobials lead the list of non-acetaminophen causes of drug-induced liver injury. In Asia, herbal compounds are the most common causes of the condition. Pravastatin was shown to be safe in patients with nonalcoholic fatty liver disease or chronic hepatitis C. The US Food and Drug Administration issued a draft guidance document on the premarketing clinical evaluation and stopping rules of drug-induced liver injury signals, including Hy's Law cases in clinical trials. SUMMARY The year 2007 brought with it several reminders of the importance of drug-induced liver injury in the clinical trial as well as the clinical practice setting. There is additional evidence that statin drugs may be used safely in patients with chronic liver disease. Comments received by the US Food and Drug Administration to finalize their guidance document are eagerly awaited.
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