The problem of comorbidity in patients with HIV infection and hepatic cirrhosis in the intensive care unit

Abstract

Objective: clinical and laboratory assessment of HIV-infected patients in the intensive care unit with liver cirrhosis that developed as a result of hepatitis of various etiologies.Materials and methods: a retrospective assessment of 91 medical records of patients with hepatic cirrhosis among 494 HIV-infected patients in the intensive care unit (ICU) was carried out in order to describe the clinical and laboratory features of the course of liver pathology against the background of HIV infection with secondary diseases. The subjects under observation were 46 (50.5%) men, 45 (49.5%) women, median age — 41 years.Results: patients were diagnosed with profound immunodeficiency (CD4+ lymphocyte count 100,000 copies of HIV RNA per 1 ml — in 45.1% of patients). Child-Pugh class C hepatic cirrhosis was diagnosed in 72.5% of patients. Cirrhosis in most cases developed as a result of toxic hepatitis in combination with chronic hepatitis C (CHC). More than half of the patients showed clinical and laboratory signs of decompensated hepatic cirrhosis. Combinations of two to five secondary infections were diagnosed in 52.8% of patients. The structure of secondary diseases was dominated by bacterial pneumonia, encephalitis and visceral candidiasis. 75.8% of patients did not receive ART, all patients did not receive antiviral therapy for chronic hepatitis.Conclusion: the mortality rate of patients with decompensated liver cirrhosis in the intensive care unit was 80.2% and was associated with the number of secondary diseases and the lack of antiretroviral therapy. Patients with a combination of HIV infection and viral hepatitis require earlier diagnosis and prescription of etiotropic therapy.

Keywords

• hiv infection
• opportunistic infections
• viral hepatitis
• hepatic cirrhosis