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 Dr Christopher J Hoffmann, assistant professor of medicine at Johns Hopkins University School of Medicine, is quoted in a Healio report as saying. “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 analysed 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-sero-negative and 49% had unknown HIV status while hospitalised, according to the research.
44% 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 non-diagnostic 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.