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

Abstract

Aim effect assessment of the order and timing in 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 were 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 condition of patients was the nature of the course of the fibrous process in the liver (progressive, stable, regressing) according to the annual transient ultrasound elastography of the liver. Results. It was found that the order of pathogens entry significantly affects the progression of liver fibrosis, while the least favorable situation arose if the first pathogen was HIV, and the interval between the entry of viral pathogens into the patient's body was at least 5 years. The degree of progression of the fibrotic process was also influenced by the combination of different mechanisms drugs for antiretroviral therapy. Conclusion. The risk of progressive liver fibrosis in HIV/HCV co-infection patients is associated with a situation where the first infecting pathogen is HIV, and an interval between coinfections is more than 5 years, and the most optimal antiretroviral therapy regimen is a combination of nucleoside reverse transcriptase inhibitors with integrase inhibitors. In HIV/HBV co-infection, the risk group for progressive liver fibrosis includes patients in whom the first pathogen is HIV, and an interval between coinfections is 5-10 years, as well as if the first pathogen was HBV with an interval between the ingestion of infectious agents for more than 10 years; the most optimal regimen of antiretroviral therapy is a combination of nucleoside reverse transcriptase inhibitors, which also have anti-HBV activity, with protease inhibitors.