Study of the functional state of liver in HIV-infected persons with the first diagnosed pulmonary tuberculosis
Simultaneous administration of anti-TB and antiretroviral therapy to patients with HIV contributes to the development of hepatotoxicity, which may be accompanied by a change in the laboratory and functional parameters of the liver. The purpose of the work is to investigate the functional state of the liver in HIV-infected persons with the first diagnosed pulmonary tuberculosis without combining with chronic hepatitis C. 49 patients were examined. The control group consisted of 25 patients with the first diagnosed pulmonary tuberculosis, the main – 24 patients with VDTB/HIV co-infection. The data of clinical, laboratory (ALT, AST, total bilirubin and its fractions, total protein of blood) and ultrasound examination before treatment and after the completion of the intensive phase of anti-TB therapy were evaluated. Clinically manifestations of intoxication were regressed more quickly in the control group. There was a statistically significant increase ALT in the main group compared to the control group after the intensive phase of treatment (p<0.05). Levels of total bilirubin and protein in both groups were not statistically different (p>0.05). The level of total bilirubin in both groups remained within the limits of physiological norm both before and after therapy. There was no significant increase those indicators, which could show the development of cholestasis syndrome. In the routine ultrasound study, conducted before and after the intensive phase, increased echogenicity of the liver, heterogeneity of the structure of the organ parenchyma, expansion of the intrahepatic ducts, hepatosplenomegaly. The presence of liver damage in patients with HIV/TB-co-infection was established at the pre-treatment stage, which wasn’t accompanied by severe clinical symptoms, consequently, in patients with HIV/TB co-infection it is expedient to conduct active monitoring of marker enzymes for cytolysis and ultrasound evaluation of liver status. The prevention of the development of medical liver damage in patients with HIV/TB co-infection contributes to the adequate implementation of an intensive phase of TB treatment.
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