Assessment of liver dysfunction using combination biomarkers In children living with HIV infection.

INTRODUCTION: Overall, around 14-18% of Non-AIDS-related deaths are due to liver disease in HIV patients. With a prevalence of 15%, cirrhosis appears to be a more serious consequence. There are many non-invasive markers for assessing liver fibrosis but their utility in pediatric HIV patients has not been explored.
METHODS: To assess the occurrence of liver dysfunction and the levels of combination biomarkers of liver dysfunction (AST/ALT ratio, AST-to-platelet ratio index (APRI), and FIB-4 index) in HIV positive children. A total of 44 HIV positive children aged <15 years attending the ART clinic were enrolled and evaluated for liver dysfunction using noninvasive biomarkers and USG scoring.

RESULTS: Deranged biomarkers- AST/ALT ratios, APRI scores, and FIB-4 index were found in 95%, 6.8%, and 4.5% children respectively. 7% of children showed moderate to severe liver fibrosis on USG scoring.Also, anemia, nevirapine in ART regimen, longer ART duration, immunosuppression, and lower BMI values were found as risk factors associated with deranged biomarkers.
DISCUSSION AND CONCLUSION: Hepatic dysfunction is reflected by deranged AST/ALT ratios among HIV-positive children in this study. Further, the elevated APRI scores and FIB 4 index in some cases signal evolving liver fibrosis.