Features of liver fibrosis in co-infections with human immunodeficiency virus and hepatitis B or C viruses

Abstract

Aim – to assess the effect of the order and time of HIV/HCV and HIV/HBV co-infections, as well as the antiretroviral therapy regimen on the progression of fibrotic changes in the liver. Material and methods. The object of the retrospective-prospective clinical study was 204 HIV/HCV co-infected patients, and 30 HIV/HBV co-infected patients, divided into groups according to the type of viral pathogen that first entered the patient's body. The criterion for assessing the patients' condition was the type of the liver fibrous process (progressive, stable, regressing) according to the annual transient ultrasound elastography of the liver. Results. It was found that the order of pathogens entry significantly affected the progression of liver fibrosis. The least favorable situation arose when the first pathogen was HIV, and the interval between the entry of viral pathogens into the patient's body was more than 5 years. The degree of the fibrotic process progression was also influenced by the combination of drugs with different action mechanisms for antiretroviral therapy. Conclusion. The risk of progressive liver fibrosis in HIV/HCV co-infection patients was associated with a situation where the first infecting pathogen was HIV, and an interval between co-infections was more than 5 years. In this case, the most optimal antiretroviral therapy regimen was a combination of nucleoside reverse transcriptase inhibitors with integrase inhibitors. In HIV/HBV co-infection, the risk group for progressive liver fibrosis included patients having HIV as the first pathogen and an interval between co-infections 5-10 years, as well as patients having HBV as the first pathogen with an interval between the infectious agents more than 10 years. The most optimal regimen of antiretroviral therapy was a combination of nucleoside reverse transcriptase inhibitors, which also have anti-HBV effect, with protease inhibitors.