Clinical characteristic and prognostic analysis of HBV-related acute on chronic liver failure in AIDS patients

Abstract

Abstract: Objective To analyze the clinical characteristic and prognosis of HBV-related acute on chronic liver failure (HBV-ACLF) in patients with acquired immune deficiency syndrome (AIDS).Methods A total of 61 HBV-ACLF patients hospitalized from June 2012 to October 2020 in Guangzhou Eighth People’s Hospital were enrolled in this study, including 22 HBV-ACLF patients with AIDS and 39 patients with isolated HBV-ACLF. Clinical data were compared between these HBV-ACLF patients with AIDS and HBV-ACLF patients. In addition, the clinical data were further analyzed between treatment improve patients and treatment failure patients with HBV-ACLF and AIDS.Results (1) The baseline characteristics did not differ between HBV-ACLF patients with AIDS and isolated HBV-ACLF patients (P>0.05), All of these patients did not receive antiviral therapy before enrolled. Serum alanine aminotransferase (Z: -2.478, P=0.013) was significantly lower in HBV-ACLF patients with AIDS compared to that of HBV-ACLF patients, whereas HBV DNA (t: 3.778, P<0.001) level was significantly higher in HBV-ACLF patients with AIDS. However, the mortality rate did not differ between these two groups of patients (54.6% vs. 46.1%, P=0.529). Among the treatment failure HBV-ACLF patients with AIDS, 2 patients (16.7%) were died of severe pulmonary infection and 10 patients (83.3%) were died of liver failure or related complications. (2) The preliminary analysis results of the clinical data in HBV-ACLF patients with AIDS showed that age (Z=-2.574, P=0.009), Meld score (t: -2.206, P=0.042) and CD4⁺T cell counts (Z=-2.374, P=0.017) were significantly lower in treatment improve patients compare to those of treatment failure patients, and alpha fetoprotein (Z=-2.317, P=0.020) was significantly higher in treatment improve patients.Conclusion The ratio of treatment failure in HBV-ACLF patients with AIDS was high, and the severity of hepatic inflammation and the prognosis may be associated with the immunity status of the patients. Effective antiviral therapy should be given to HIV/HBV co-infected patients prior to HBV-ACLF occurred.

Key words: HBV-related acute on chronic liver failure, Acquired immune deficiency syndrome, Clinical analysis, Antiviral therapy

DENG Hao-hui, LOU Yan, GAO Hong-bo, CHEN Wei-lie. Clinical characteristic and prognostic analysis of HBV-related acute on chronic liver failure in AIDS patients[J]. Chinese Hepatolgy, 2022, 27(1): 63-67.

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