Skip to main content Skip to main navigation menu Skip to site footer
Published: 2020-04-30

Particularities of clinical - laboratory and instrumental markers of the digestive system comorbid pathology in HIV-infected patients in the context of family medicine practice

Bogomolets National Medical University
HIV infection Digestive system Diagnostic markers Family medicine

Abstract

Introduction. Ukraine remains in second place among the largest countries with HIV - epidemic in Eastern Europe and Central Asia, with one of the highest infection rates among European region’s countries. The issues of comorbidity of various pathologies, including HIV - infection with digestive system diseases, and the increasing role of family medicine in the detection and treatment of many chronic gastroenterological diseases in HIV-infected patients become actual in Ukraine.

Purpose of the study. To study the characteristics of clinical, laboratory and instrumental markers of the digestive system comorbid pathology in HIV-infected patients in the context of clinical diagnostic value for the family medicine practice.

Material and methods. The 96 patients with HIV infection, who were monitored in HIV / AIDS centers in different regions of Ukraine during 2017-2019 years were examined: the main group (MG) of the study was 54 (56.2%) HIV-infected patients with digestive system pathology and the control group (CG) - 42 (43.8%) HIV-infected patients, who did not have a comorbid pathology of the digestive system. The examination included general clinical, biochemical, serological, molecular genetic studies, ultrasound of the abdominal organs in 2D scanning mode in two projections.

Results and its discussion. In both groups, astheno-vegetative and dyspeptic syndromes were observed, but their manifestations in the MG appeared significantly more often (p <0.05), than in the CG and were more expressed. Among laboratory parameters in patients with comorbid pathology, anemia and thrombocytopenia were more often found, and the incidence of leukopenia increased with increasing immunodeficiency and had an inverse correlation with the number of CD4+ T cells. Among MG patients in comparison with CG the frequency of increased transaminase activity was higher, which may be due to the high frequency of liver damage in this group of patients. The highest activity of liver enzymes was determined in patients with comorbid pathology and severe immunodeficiency. According to the ultrasound results in MG patients the hepato- and splenomegaly, signs of portal hypertension, changes in the pancreas were more often detected and more significant.

Conclusion. In HIV-infected patients with pathology of the digestive system, manifestations of astheno-vegetative and dyspeptic syndromes, changes in general clinical, biochemical and ultrasound markers were significantly more often observed and more expressed. These markers of comorbid pathology of the digestive system in HIV-infected patients are available for monitoring and control in current practice of primary care clinics for timely diagnosis and effective treatment of digestive system pathology in HIV-infected patients by family physicians.

Full-text of the article is available for this locale: Українська.

References

  1. Avert. HIV and AIDS in Ukraine. Brighton: Global information and education on HIV and AIDS; 2018. URL: https://www.avert.org/printpdf/node/2201
  2. Global AIDS Update. Joint United Nations Programme on HIV/AIDS. Geneva: UNAIDS; 2016:2-5. URL: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf
  3. Global AIDS update. Communities at the centre, defending rights, breaking barriers, reaching people with HIV services, UNAIDS Joint United Nations Programme on HIV/AIDS. Geneva: UNAIDS; 2019:283-93.https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf
  4. UNAIDS in Ukraine. Ukraine on a Fast Track to End AIDS by 2030. Geneva: UNAIDS; 2019. URL: https://unaids.org.ua/ua/hiv-epidemic-in-ukraine/epidemiologichna-situatsiya#1
  5. Center for Public Health of the Ministry of Health of Ukraine. HIV / AIDS statistics. Kyiv: Center for Public Health of the Ministry of Health of Ukraine; 2019. https://phc.org.ua/kontrol-zakhvoryuvan/vilsnid/statistika-z-vilsnidu
  6. UNAIDS in Ukraine. UNAIDS Strategy 2016-2021 On the Fast-Track to end AIDS. Geneva: UNAIDS; 2019. URL: https://www.unaids.org.ua/ua/about-unaids/strategiya-stalogo-rozvitku
  7. UNAIDS. On the fast-track to end AIDS, 2016–2021 strategy. Geneva: UNAIDS; 2015. URL: http://www.unaids.org/sites/default/files/media_asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf
  8. UNITAID Secretariat World Health Organization. Hepatitis C medicines: technology and market landscape. Geneva: UNITAID Secretariat World Health Organization; 2015. URL: https://unitaid.org/assets/HCV_Meds_Landscape_Feb2015-1.pdf
  9. Center for Public Health of the Ministry of Health of Ukraine. The state strategy to combat HIV/AIDS, tuberculosis and viral hepatitis until 2030. Kyiv: Center for Public Health of the Ministry of Health of Ukraine; 2019. URL: https://www.phc.org.ua/news/derzhavna-strategiya-protidii-vil-infekciisnidu-tuberkulozu-ta-virusnim-gepatitam-do-2030-roku
  10. Kolpakova NV, Kurmangulov AA, Mel’nikov AA, Uvarova NA, Petrova UA. Clinical, amnestic and immunological parameters in HIV-infected patients with gastroenterological diseases. HIV Infection and Immunosuppressive Disorders. 2018;10(1):78-83. DOI: https://doi.org/10.22328/2077-9828-2018-10-1-78-83
  11. Platt L, Easterbrook P, Gower E, et al. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Lancet Infect Dis. 2016;16(7):797-808. DOI: https://doi.org/10.1016/S1473-3099(15)00485-5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26922272
  12. Anderson KB, Guest JL, Rimland D. Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: data from the HIV Atlanta VA Cohort Study. Clin Infect Dis. 2004;39(10):1507–13. DOI: https://doi.org/10.1086/425360 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15546088
  13. Laguado VLD, Rodríguez ARM, Gómez CJ, Bonilla GRA, Rojas G. Endoscopic and pathological findings in patients with HIV and digestive symptoms at a university hospital. Rev Col Gastroenterol. 2016;31(2):111-8. DOI: https://doi.org/10.22516/25007440.80.
  14. Mudd JC, Brenchley JM. Gut Mucosal Barrier Dysfunction, Microbial Dysbiosis, and Their Role in HIV-1 Disease Prossion. The Journal of Infectious Diseases. 2016; 214(2). DOI: https://doi.org/10.1093/infdis/jiw258 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27625432
  15. Dharan NJ, Neuhaus J, Rockstroh JK, et al. Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial. Hepatology. 2019;69(3):1135-50. DOI: https://doi.org/10.1002/hep.30296 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30298608
  16. Karstaedt A. Digestive Diseases in Sub-Saharan Africa. Chapter 11 - HIV and the Digestive System. Johannesburg: Changes and Challenges; 2019:101-8. DOI: https://doi.org/10.1016/B978-0-12-815677-3.00011-6
  17. Bourgi K, Wanjalla C, Koethe JR. Inflammation and Metabolic Complications in HIV. Curr HIV/AIDS Rep. 2018;15(5):371–81. DOI: https://doi.org/10.1007/s11904-018-0411-2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30058057
  18. Chu C, Pollock LC, Selwyn PA. HIV-Associated Complications: A Systems-Based Approach. Am Fam Physician. 2017;96(3):161-9. URL: https://www.aafp.org/afp/2017/0801/p161.pdf PMID: https://www.ncbi.nlm.nih.gov/pubmed/28762691
  19. Romanelli F, Matheny SC. HIV Infection: The Role of Primary Care. Am Fam Physician. 2009;80(9):946-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19873961 URL: https://www.aafp.org/afp/2009/1101/p946.html
  20. Cheng QJ, Engelage EM, Grogan TR, Currier JS, Hoffman RM. Who Provides Primary Care, An Assessment of HIV Patient and Provider Practices and Preferences. J AIDS Clin Res. 2014;5(11). DOI: https://doi.org/10.4172/2155-6113.1000366 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25914854
  21. US Department of State. US President’s Emergency Plan for AIDS Relief (PEPFAR). Washington: US Department of State; 2019. URL: https://www.state.gov/pepfar-policies/