Assessment of the liver in an HIV era: clinical, laboratory and radiological abnormalities.

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.