Assessment of the liver in an HIV era: clinical, laboratory and radiological abnormalities.
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Date
2020
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Abstract
Background: Liver – related mortality and morbidity are an increasing burden worldwide.
Aim: To outline the pattern of liver abnormalities at a tertiary hospital in KwaZulu Natal (KZN),
Durban, South Africa, during the era of the HIV epidemic.
Methods: This cross-sectional, retrospective study conducted medical records review of all patients
found to have liver abnormalities based on clinical, laboratory, and radiological profile, admitted to
the medical wards for the period between June 2016 to December 2016.
Results: A total of 157 patients were included, of which 63.1% were males, and 91.7% were black,
with a median age of 41 years (IQR, 32–54). Sixty – six (42.0%) patients were HIV negative; 91
(57.9%) were HIV infected, of which 51 (56.0%) were on antiretroviral therapy. Only 15 (29.4%) had
an HIV viral load of < 50 copies/mL and 21 (30.9%) with a CD4+ count of ≥ 200 cells/mm3. In HIV
negative, heart failure (48.5%) was the main cause of liver abnormalities (p-value < 0.001), whereas
in HIV infected, abdominal TB (24.2%) and DILI (18.7%) were the commonest. Sixty- seven (42.7%)
patients died while admitted, and leading causes were HIV/AIDS (40.3%), hypertension (13.4%), and
metastatic cancer (13.4%).
Conclusion: In HIV infected patients, abdominal TB was common, which was consistent with the
common presenting symptoms of fever and vomiting in this group; whereas in HIV negative, heart
failure was the commonest which was also consistent with the leading presenting symptoms of
abdominal distension and ascites, and comorbid conditions of hypertension, diabetes mellitus, and
dyslipidaemia which are all risk factors of cardiac diseases. Also, mortality was significantly high,
and the leading causes were HIV/AIDS, hypertension, and advanced malignancy, which underscores
the need to strengthen community-based screening programs for both communicable and noncommunicable
disease for early detection and referral to care.
Description
Masters Degree. University of KwaZulu-Natal, Durban.