Occurrence of Hepatotrophic Viral Infections among patients in Tertiary Care Center.

Prema Malini, T (2006) Occurrence of Hepatotrophic Viral Infections among patients in Tertiary Care Center. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Hepatic abnormalities are quite common among HIV infected persons. Thousands of people with HIV are also infected, or at risk of being infected with one of the several hepatitis viruses. Some of these viruses can cause chronic infection which may result in cirrhosis, liver failure, and hepatocellular carcinoma in a proportion of patients. Apart from being more prevalent, the natural history of these hepatitis viruses may be modified in patients with HIV infection and hence their significance3. Also it has been claimed that certain hepatitis virus infections may exacerbate the course of HIV infection, with rapid progression to AIDS, although this observation has not yet been confirmed. Viral hepatitis is not so much an opportunistic infection in patients with HIV infection, as it is companion infection. Thus because some forms of hepatitis are acquired through sexual spread, or parenteral contact with blood or blood products in the same way that HIV is, hepatitis and HIV infections often coexist. The enteral forms of hepatitis (HAV and HEV) are not strongly associated with HIV infection, whereas HBV, HDV, HCV and HGV are strongly associated because of shared routes of transmission. So screening of these hepatitis viral infections becomes mandatory in HIV positive patients. AIMS AND OBJECTIVES : • To study the serological status of hepatotrophic viral infections like HBV and HCV among HIV positive and HIV negative patients attending Voluntary Confidential Counselling and Testing Centre (VCCTC), Government General Hospital, Chennai. • To compare the progression of Hepatitis B virus infection among HIV positive and HIV negative study groups. • To compare the levels of anti HBs, among HIV positive and HIV negative study groups with hepatitis B virus infection, during follow up. • To detect the prevalence of HGV RNA using the RT-PCR among HIV positives with coexistent HBsAg and/ or anti HCV. • To study the clinical stage and immunological status of patients with HIV infection at presentation, and their correlation with hepatotrophic viral infections. MATERIALS AND METHODS : This study was conducted in serologically confirmed HIV positive and negative patients attending VCCTC, Government General Hospital, Chennai. Pre and post test counselling were given to the patients attending VCCTC, and informed consent was got from them for testing. Strict confidentiality regarding the results were maintained. For ELISA, blood samples were collected from the patients. Serum was separated, and stored at -20°C in cold storage, until use. For all the ELISAs performed, the manufacturer’s testing protocol instructions were strictly followed and results were interpreted only when the validity criteria were satisfied. RESULTS : In the present study 500 HIV positive and 300 HIV negative patients attending VCCTC, Government General Hospital, Chennai were screened for the coexistence of hepatotrophic virus infections. Majority of the HIV positives were in the sexually active age group of 30 – 39 years ( 52%), with males being more than females in the ratio of 1.9: 1. Prevalence of Hepatitis B surface antigen was more both among HIV positives and negatives, when compared to anti HCV antibodies. The persistence of Hepatitis B surface antigen after 6 months was three times more among the HIV positives, when compared to the HIV negative study group. The presence of HBeAg which indicates active replication was also more among HIV positives when compared to negative study group. HIV negative patients had higher antibody levels, when compared to HIV positive study group. Among the 5 patients who had chronic HBV infection (Table III), 2 had coexistent anti-HBs in their serum. Heterosexual route was the major mode of transmission of HIV. The heterosexuals also included the spouse of infected men. Heterosexual route was the major mode of transmission of HBV. HCV was more prevalent among IVDUs. Among the total 16 IVDUs (Table II), 2 (12.5% ) were positive for both HBsAg and Anti HCV. Majority of the HIV positives without hepatotrophic viral infections were in Clinical Stage II Category B of HIV infection. Majority of the patients who were positive for hepatitis viral markers were in Clinical Stage II Category C of HIV infection CONCLUSION : HGV infection occurs with high frequency in patients with HIV and HCV combined infections (35%), signifying the common modes of transmission of HGV and HCV. Among the HIV positive study group, HBsAg positives with HGV co-infection had higher mean CD4 counts, when compared to HBsAg positives without HGV co-infection. There was no significant difference observed between the HCV positives with or without HGV co-infection. This implies that the presence of HGV RNA is associated with milder HIV status in individuals with HIV and HBV combined infection. Among the HIV positive study group, HGV positive patients with hepatitis B and / or hepatitis C co-infections had higher mean ALT levels, when compared to HGV negative individuals. This implies that, presence of HGV RNA was associated with severe hepatitis in patients with HIV and HBV or HCV combined infections. The present study throws light upon the co existence of HIV with Hepatotrophic viruses in a tertiary care center like ours. Only very few studies have been performed in India analyzing the coexistence of HGV with HIV. Our study can be considered as pioneer study in this context. The results aid the central HIV programme implementing agencies, especially in the field of ART to give importance to hepatitis G virus, along with hepatitis B and hepatitis C viral infections.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Occurrence ; Hepatotrophic Viral Infections Among Patients ; Tertiary Care Center.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:37
Last Modified: 16 Aug 2017 02:20
URI: http://repository-tnmgrmu.ac.in/id/eprint/1785

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