Clinical features and prognosis of AIDS complicated by drug-induced liver injury: an analysis of 119 cases

Objective To investigate the clinical features and prognosis of AIDS patients complicated by drug-induced liver injury ( DILI) . Methods A total of 119 patients who were diagnosed with AIDS in First Department of Infectious Diseases in Shanghai Public Health Clinical Center from January 2014 to December 2015 and met the diagnostic criteria for DILI were enrolled. The clinical data including medications, CD4~+T lymphocyte count, clinical manifestations, liver biochemical parameters, therapies, duration of liver injury, and prognosis were analyzed, and DILI type and classification were determined for all patients. The influence of DILI caused by different drugs on liver biochemical parameters was analyzed. The Wilcoxon rank sum test was used for comparison of continuous data between two groups and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results The 58 patients who received highly active antiretroviral treatment ( HAART) had significantly higher grade of liver injury ( χ2= 15. 756, P < 0. 001) and levels of total bilirubin ( TBil) ( Z =-3. 466, P = 0. 010) and albumin ( Alb) ( Z =-1. 968, P = 0. 049) than the 61 patients who did not. Among the patients who had a clear cause of DILI, 8 had DILI caused by antifungal drugs, 41 had DILI caused by antibacterial drugs, 18 had DILI caused by antitubercular agents, and 24 had DILI caused by antiviral drugs; the patients with DILI caused by antitubercular agents had a significantly higher level of TBil than those with DILI caused by other three types of drugs ( H = 12. 804, P = 0. 005) , the patients with DILI caused by antibacterial drugs and antitubercular agents had a significantly lower level of Alb than those with DILI caused by the other two types of drugs ( H = 14. 236, P = 0. 003) , and the patients with DILI caused by antitubercular agents and antiviral drugs had a significantly higher grade of liver injury than those with DILI caused by the other two types of drugs ( χ2= 16. 373, P = 0. 008) . The hepatocellular injury-type patients had a shorter length of hospital stay ( χ2= 8. 046, P = 0. 045) .A high level of alkaline phosphatase and a low level of alanine aminotransferase indicated a longer length of hospital stay ( Z =-2. 943 and-2. 592, both P < 0. 05) . Conclusion AIDS patients are given various drugs and have a high incidence rate of DILI. HARRT can aggravate liver injury, but it does not significantly affect patients' prognosis. Liver function examination should be performed regularly during clinical medication to know the state of liver inflammation and reduce the incidence rate of DILI in AIDS patients.