AbstractThe objective of the research was to investigate the state of the liver parenchyma and its blood flow based on echogenic characteristics during ultrasound examination in patients with co-infection of tuberculosis / HIV in combination with viral hepatitis B and C.Materials and methods. Ultrasonic features of liver injury were studied in 58 patients with co-infection of with tuberculosis (TB)/HIV (FDTB) in combination with viral hepatitis B and/or C (VH). Patients were examined before the start of TB chemotherapy. The ultrasonography results were compared with the indications of 58 co-infected TB/HIV patients without viral hepatitis at the beginning and during of anti-TB treatment (after 2 months of intensive phase (IP)).Results. Ultrasound signs of liver damage manifested in hepatomegaly, decreased or increased parenchymal echogenicity and portal blood flow parameters were observed in more than 50% of patients with concomitant viral hepatitis. In 68.6% of cases these violations were asymptomatic and without an increase in ALT, AST. At the beginning of TB treatment ultrasound signs of liver damage were rare in patients without viral hepatitis. After the intensive phase of chemotherapy ultrasound signs of liver disease were observed in 18.9 % of patients with increased echogenicity of the liver parenchyma and blood flow. Significantly increased rates of ALT, AST were observed in 10 out of 15 (66.7 %) patients with increased hepatic blood flow parameters. Severe hepatotoxic reactions were noticed in 13.3% of cases.Conclusions. Ultrasonography is addition to laboratory methods which diagnose changes in the state of the liver and allocate the risk group of the increased adverse reactions to anti-tuberculosis drugs.
Petrenko V.I. The modern approach to the problem of combined triple infection: TB, HIV / AIDS, hepatitis B and C. Tuberkulioz. Lehenevi khvoroby. VIL-infektsiia. 2012; 4(11): 5-11.
Ungo J. R. [et al.] Antituberculosis drug-induced hepatotoxicity. The role of hepatitis C virus and the human immunodeficiency virus. Am. J. Respir. Crit. Care Med. 2002; 157: 1871-1876.
Yee D. [et al.] Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am. J. Respir. Crit. Care Med. 2003; 167: 1472–1477.
Padmapriyadarsini C. [et al.] Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function. J. Postgrad. Med. 2006; 52: 92-96.
Hoffmann C.J. [et al.] Hepatotoxicity in an African antiretroviral therapy cohort: the effect of tuberculosis and hepatitis B. AIDS. 2007; 21: 1301-1308.
Gunawan, B.K. Kaplowitz N. Mechanism of drug-induced liver disease Clin. Liver Dis. 2007; 11: 459-475.
Lee, W.M. Drug-Induced Hepatotoxicity. N. Engl. J. Med. 2003; 349 (5) : 474-485.
Lima, M. F., Melo H. R. Hepatotoxicity Induced by antituberculosis drugs among patients coinfected with HIV and tuberculosis. Cadernos de Saude Publica. 2012; 28 (4): 698-708.
Orofino R. D. [et al.] Predictors of Tuberculosis Treatment Outcomes Bras. Pneumol. 2012; 38 (1): 88-97.
Sirinak C. [et al.] Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment outcomes in Thailand. BMC Public Health. 2008; 8: 245-249.
Gaiani S. [et al.] What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. J. Hepatology. 1997; 27: 979-985.
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