关键词: 艾滋病病毒, 获得性免疫缺陷综合征, 慢加急性肝衰竭, 临床分析

Abstract: Objective To analyze the clinical characteristics of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) patients complicated with acute-on-chronic liver failure (ACLF), for improving standardized diagnosis and treatment of these conditions.Methods The clinical data of 121 HIV/AIDS patients complicated with ACLF were retrospectively analyzed. Results Among the 121 HIV/AIDS patients with ACLF, 93 cases (76.9%) were middle-aged males, and 85 cases (70.2%) were from rural areas. HIV infection was mainly transmitted through heterosexual contact in 71 cases (58.7%), and through intravenous drug abuse in 48 cases (39.7%). Sixty-seven cases (55.4%) of ACLF were caused by hepatitis C virus (HCV) infection and 61 cases (50.4%) were due to hepatitis B virus (HBV) infection. Ninety-five cases (78.5%) were C-type in clinical classification. Fifty-two cases (42.9%) was in advanced stage. The common clinical manifestations of these patients including jaundice in 121 cases (100.0%), fatigue and anorexia in 109 cases (90.1%), nausea and oil aversion in 101 cases (83.5%), abdominal distension in 97 cases (80.2%), abdominal pain in 82 cases (67.8%), hypoalbuminemia (ALB＜25 g/L) in 78 cases (64.5%), and hematemesis or hematochezia in 65 cases (53.7%). Complications of ACLF that occurred in these patients including ascites in 89 cases (73.6%), electrolyte disturbance in 83 cases (68.6%), spontaneous peritonitis in 81 cases (66.9%), pulmonary infection in 77 cases (63.6%), sepsis in 69 cases (57.0%), upper gastrointestinal bleeding in 62 cases (51.2%). In laboratory examination, alanine aminotransferase (ALT) and total bilirubin (TBIL) levels in liver function test significantly increased, and international normalized ratio (INR) in coagulation function elongated. Meanwhile, the level of procalcitonin and the total number of leukocyte in peripheral blood elevated. The CD4⁺T lymphocyte count (＜200/μL) was found to significantly decrease in 51 cases (42.1%) and HIV viral load (＞1000 copies/mL) was high in 59 cases (48.8%). The results of abdominal color ultrasound examination were varied without specificity.Conclusion The phenomenon of HIV/AIDS patients complicated with ACLF in Liangshan prefecture is prominent, with individual features in different clinical stages. It is essential to further strengthen the early monitoring and intervention of abnormal liver function in HIV/AIDS patients.

Key words: Human immunodeficiency virus, Acquired immunodeficiency syndrome, Acute-on-chronic liver failure, Clinical analysis