Cytomegalovirus Contributing to Liver Disease in HIV-Patients presenting at University Teaching Hospital-Zambia

Abstract

Little research has been performed to compare Cytomegalovirus (CMV) hepatitis with the traditional viral hepatitides (Hepatitis A, B and C) in patients with Human Immunodeficient Virus (HIV) . It is a well known fact that an HIV-positive patient co-infected with HBV or and HCV has increased mortality due to liver failure. However, screening for these viral hepatitides by other researchers has not demonstrated an association with HIV, and the prevalence in HIV infected adults is similar to that in adults uninfected with HIV. In older studies, cytomegalovirus was the commonest virus found in liver biopsies in HIV-positive patients. Currently, there is a major problem in UTH with HIV positive patients presenting with hepatitis as they have a high mortality rate.A case-control study was conducted at the University Teaching Hospital, Lusaka, Zambia to ascertain the prevalence of CMV in HIV-positive patients dying of liver dysfunction (cases)compared with those dying due to non-liver related causes (controls). I began with a study of the burden of liver disease in patients being admitted, then those who died were included in the postmortem study. Inclusion criteria were: jaundice with other abnormal liver function tests, HIV seropositive, and aged 15 years and above. Exclusion criteria included: obstructive jaundice identified on ultrasound, haemolytic jaundice, HIV seronegative, age below 15 years and previous history of jaundice. I studied 598 potential study participants and autopsy was performed on 45 cases, and 36 controls. Liver tissue was collected for PCR diagnosis of CMV. Out of the 45 cases only one was positive for CMV and none of the controls came out positive by PCR. However, post-mortem findings suggest that bacterial infection was a dominant cause of death in HIV infected adults presenting with liver dysfunction and this will need to be looked at further. This study showed that CMV is not the cause of liver dysfunction/hepatitis in HIV patients though it is known to cause other manifestations of AIDS such as retinitis and gastro-intestinal ulceration.