A CLINICAL STUDY OF CO-INFECTION OF HEPATITIS B AND HEPATITIS C VIRUS IN HIV INFECTED PATIENTS IN CORRELATION WITH CD4 COUNT AND LIVER ENZYMES

Abstract

Background: Human immunodeficiency virus (HIV) and Hepatitis B and C virus (HBV&HCV) are three most common chronic viral pathogens of major public health concerns. These viruses have similar routes of transmission, namely through blood and blood products, sharing of needles to inject drugs and sexual activity. People at high risk for HIV are also likely to be at risk for other infectious pathogens, including HBV or HCV enabling co-infection with these viruses a common event.In co-infection, the presence of one virus impacts the natural history of the other virus. HIV accelerates the natural course of HBV and HCV infection and facilitates faster progression of liver disease to cirrhosis and hepatocellular carcinoma. Objective: To study the prevalence, risk factors (probable mode of acquisition), signs and symptoms of co-infection of Hepatitis B and Hepatitis C virus in HIV infected patients in correlation with CD4 count and liver enzymes. Methodology: The information for the study was collected from HIV positive patients admitted to BLDEU’S Shri B.M Patil Medical college Hospital and Research center,Vijayapur from November 2015 to June 2017.Information was collected through prepared proforma from each patient. All patients were interviewed as per the prepared proforma and then complete clinical examinationwas done. Inclusion Criteria: • HIV infection diagnosed as per NACO guidelines– Diagnosed by 3 spot tests:1. Coombs AIDS test 2. Triline test 3.Qualpro test IX Exclusion Criteria: 1. HIV negative patents. 2. Patients not willing to take part in the study. Results: Common age group for HIV positive patients was 31-40 years (41.7%). Males out number females with ratio of 13:7 [64.9% : 35.1%]. Multiple sexual partner behaviour as a risk factor for HIV accounted for about 46.4%. HbsAg positive in HIV positive individuals were recorded in 31 patients (14.7%). Anti HCV antibodies status in HIV positive individuals were recorded in 8 patients (3.8%). The age group of 31-40 years was the commonest period for HBV and HCV co-infection in HIV individuals. Mean CD4 counts were 154.3 and 135.5 for HbsAg and Anti HCV positive HIV patients respectively. Mean SGOT and SGPT levels were 229.4 and 168.4 respectively in HbsAg positive HIV patients. Mean SGOT and SGPT levels were 467.6 and 239.8 respectively in Anti HCV positive HIV patients. Mean Serum bilirubin was 1 and 2.4 in HbsAg positive and Anti HCV positive HIV patients respectively. Conclusion: Co-positivity with HBV in HIV positive patients was found to be 14.7%. Copositivity with HCV was found to be 3.8%. Age group 31-40 years showed highest co-positivity for HBV. Age group 31-40 years showed highest co-positivity for HCV. Study showed Male preponderance. Study also shows that highest co-positivity is seen in patients whose CD 4 count was <200. Liver enzymes are markedly elevated in co-infected cases. Study of viral DNA levels could not be done because of nonavailability of facilities in our set up; this could have been more sensitive in finding the exact co-positivity of HbsAg and Anti HCV with HIV infection.