The Impact of Hepatitis B and/or C on Liver Function and on the Response to Antiretroviral Therapy in HIV-Infected Patients: A Romanian Cohort Study

Abstract

Background: Hepatitis B (HBV) and C (HCV) virus coinfections remain major contributors to liver-related morbidity and mortality among people living with HIV (PLWH). This study aimed to assess the prevalence of HBV and/or HCV coinfections in a Romanian HIV cohort and to evaluate their impact on immunological, virological, and liver function parameters under antiretroviral therapy (ART). Methods: We retrospectively analyzed 462 HIV-infected patients (2018-2021) from the National Institute of Infectious Diseases, Bucharest, stratified into four groups: HIV mono-infection (n = 176), HIV/HBV (n = 114), HIV/HCV (n = 97), and HIV/HBV/HCV (n = 75) coinfections. Immunological (CD4 count, CD8 count, and CD4/CD8 ratio), virological (HIV-1 RNA), and hepatic parameters (ALT, AST, GGT, bilirubin, amylase, and lipase) were compared. Results: No significant differences were observed between groups regarding the immune recovery (mean CD4 count p = 0.89, HIV-RNA suppression p = 0.78). However, liver and pancreatic parameters showed statistically significant deterioration in the coinfected groups. ALT (p < 0.001), GGT (p = 0.009), total bilirubin (p = 0.011), amylase (p = 0.010), and lipase (p < 0.001) were significantly higher in the triple-infection (HIV/HBV/HCV) group compared to HIV mono-infected patients. Coinfection was also associated with a longer duration of illness (p = 0.002) and therapy (p = 0.021) and with a higher number of ART regimens used (p = 0.013). Conclusions: While HIV suppression and immune recovery were not significantly impaired by HBV/HCV coinfections, liver and pancreatic injuries were significantly more prevalent and severe in coinfected patients. Regular monitoring of hepatic function and integrated management strategies are recommended to minimize liver-related complications in this population.

Keywords: HIV; antiretroviral therapy; coinfections; hepatitis B; hepatitis C; immune recovery; liver and pancreatic impairment.

Figure 1

The median value within the studied group for: (a) number of years of illness; (b) number of years of therapy; (c) number of ARV regimens.

Figure 2

The linear regression graphic showing the correlation between the recent CD4 count cells/mm³ and: (a) the number of years of illness; (b) the number of years of therapy.

Figure 3

The linear regression graphic showing the correlation between the recent CD4 count cells/mm³ and nadir CD4.

Figure 4

The linear regression graphic showing the correlation between (a) the recent CD4 count cells/mm³ and the number of years of therapy; (b) the recent HIV1-RNA viral load copies/mL and the CD4 count cells/mm³ at diagnosis.

Figure 5

Hepatic parameters median values within the studied groups: (a) ALT/AST ratio, (b) alanine aminotransferase (ALT), (c) aspartate transaminase (AST), (d) direct bilirubin, (e) indirect bilirubin, (f) total bilirubin, (g) alkaline phosphatase, (h) gamma-glutamyl transferase (GGT), (i) lipase, and (j) amylase.

Figure 5

Hepatic parameters median values within the studied groups: (a) ALT/AST ratio, (b) alanine aminotransferase (ALT), (c) aspartate transaminase (AST), (d) direct bilirubin, (e) indirect bilirubin, (f) total bilirubin, (g) alkaline phosphatase, (h) gamma-glutamyl transferase (GGT), (i) lipase, and (j) amylase.