Bacterial translocation in HIV-infected patients with HCV cirrhosis: implication in hemodynamic alterations and mortality.

Abstract

OBJECTIVE:

Analysis of the influence of portal hypertension on intestinal permeability in HIV-infected patients with hepatitis C virus (HCV)-related cirrhosis and of the prognostic significance of consequent macrophage activation.

METHODS:

Twenty HIV-monoinfected patients, 70 patients with HIV-HCV coinfection, 20 of them with compensated and 50 with decompensated cirrhosis, and 20 healthy controls were evaluated for intestinal permeability [measured by lipopolysaccharide-binding protein (LBP) serum levels], macrophage activation [soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and interleukin 6 (IL-6)], and activation of the rennin-angiotensin-aldosterone axis. Patients with decompensated cirrhosis were monitored for a median period of 429 days to analyze the prognostic factors implicated in survival.

RESULTS:

Patients with decompensated cirrhosis show increased LBP levels compared with HIV-monoinfected patients. Patients with increased LBP concentration showed elevated soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and IL-6 levels. Twenty-two patients died, from liver-related causes, during the follow-up, and 2 more underwent liver transplantation. Child-Pugh index, CD4 T-cell count, plasma aldosterone and serum IL-6 concentrations independently predicted liver-related mortality.

CONCLUSIONS:

Increased intestinal permeability, as measured by serum LBP levels, observed in patients with HIV infection is significantly higher in patients with decompensated liver cirrhosis. Proinflammatory cytokines (IL-6) are prognostic markers of HIV-HCV-coinfected patients with decompensated cirrhosis.

• Authors: Montserrat Montes de Oca Arjona, Mercedes Marquez, Maria Jose Soto, Claudio Rodriguez-Ramos, Alberto Terron, Antonio Vergara, Ana Arizcorreta, Clotilde Fernandez-Gutierrez, Jose Antonio Giron-González
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 56 Issue 5 Pg. 420-7 (Apr 15 2011) ISSN: 1944-7884 [Electronic] United States
• PMID: 21266909 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Acute-Phase Proteins
• Carrier Proteins
• IL6 protein, human
• Interleukin-6
• Membrane Glycoproteins
• lipopolysaccharide-binding protein

Topics

• Acute-Phase Proteins
• Adult
• Bacterial Translocation (physiology)
• Carrier Proteins (blood)
• Female
• HIV Infections (complications, mortality, virology)
• HIV-1
• Hepacivirus
• Hepatitis C (complications, mortality, virology)
• Humans
• Hypertension, Portal (complications, mortality)
• Interleukin-6 (blood)
• Intestines (microbiology)
• Liver Cirrhosis (complications, mortality, physiopathology, virology)
• Macrophage Activation
• Male
• Membrane Glycoproteins (blood)
• Middle Aged
• Permeability
• Prognosis
• Survival Analysis