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Protective efficiency of "Phosphogliv" at high active antiretroviral therapy in patients with HIV-infection...
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Bayjanov Allabergan Kadirovich, Research Institute of Virology, Ph. D. (candidate of Medical Science) E-mail: [email protected]
Protective efficiency of "Phosphogliv" at high active antiretroviral therapy in patients with HIV-infection, associated with chronic viral hepatitis C
Abstract: Purpose of research was assessment of the hepatoprotector efficacy in high active antiretroviral therapy (HAART) in the patients with HIV-infection associated with chronic viral hepatitis C. There has been studied efficacy of the drug hepatoprotector "Phosphogliv" in the complex of specific HAART in the patients with HIV-infection associated with chronic viral hepatitis C, and it has been established that the positive dynamics has been noted as in relation to clinical symptoms (attenuation and/or elimination of clinical expressions of disorders in the hepatobiliary system), so as in the biochemical characteristics, which has been expressed by reduction in the contents of total bilirubin, activity of transaminases, thymol test, AP and GGTP, insignificant reduction of the contents of cholesterol and glucose in the blood.
Keywords: HIV-infection, phosphogliv, high active antiretroviral therapy, chronic viral hepatitis C, treatment.
Antiretroviral drugs are hepatotoxic [1; 3; 6; 10]. There was chosen drug "Phosphogliv" with purpose of reduction of hepa-totoxicity of antiretroviral drugs in treatment of the patients with HIV-infection associated with chronic viral hepatitis C [5; 9]. Phosphogliv is a hepatoprotector. Phospholipids have ability to effect on the state of the cellular membranes as their integral components and have strong hepatoprotective effect on the liver. This drug prevents atrophy of the cellular structures in the liver, normalizes activity of the alaninaminotransferase (ALT) and aspartataminotransfer-ase (AST). Phosphogliv is used in dose 2 capsule 3 times a day during 3 months in hepatitis of various etiology. Taking into account that one of the unfavourable effect of HAART is hepatotoxicity, the study of efficacy of Phosphogliv with purpose of reduction of hepatotoxicity of HAART in the patients with HIV-infection associated with chronic viral hepatitis C seems to be rational.
Material and methods. Our surveillance covered only 65 patients with HIV-infection associated with chronic viral hepatitis C at the age of16 to 58 years. The patients were divided into 2 groups: studied group consisted of patients with HIV-infection associated with chronic viral hepatitis C, who were prescribed phosphogliv additionally to HAART ( n = 36), control group was composed of patients with HIV-infection associated with chronic viral hepatitis C who received HAART without phosphogliv (n = 29).
The patients were comparable in relation to sex, age, health state, clinical stages of HIV-infection, presence of accompanied and opportunistic infections. In the both groups the general health state was evaluated as of moderate severity.
The diagnosis of "chronic viral hepatitis C" in the studied patients was verified on the basis of epidemiological, clinical and
laboratory data (by method of immunoenzymatic analysis there were revealed antiHCV in blood, with method ofpolymerase chain reaction the quantitative and qualitative determination ofviral hepatitis C RNA — HCV RNA was performed).
HAART was prescribed for the patients in the both groups according to the recommendations of the World Health Organization (WHO). The patients of the both groups received schemes HAART without hepatotoxic drug nevirapin. The patients in the both groups did not receive specific antiviral preparations against viral hepatitis C.
According to a number of authors hepatic toxicity of the antiretroviral preparations is often observed in the first 4 weeks (to 3 months after prescription of HAART) [2; 4; 7; 8].
So, the patients were examined before onset and one month after HAART prescription.
The complex clinical-biochemical examination included assessment of the treatment efficacy by dynamics of the clinical symptoms of the hepatobiliary system impairment and biochemical blood parameters.
The determination of the total protein in the blood serum was performed with use of biuretic method, and albumin concentration in the blood serum was measured by unified colorimetric method. There were used reagents of the Manufacture OOO "Olvex Diagnosticum" (Russia).
Activity ofAlT, AsT, y-glutamiltranspeptidasa (GGTP) and alkaline phosphatase (AP) in the blood serum was determined with kinetic US method (IFCC) with kits of reagents of firm "Herbos Diagnostika" (Croatia).
The level of bilirubin total and its fractions in the blood serum was determined with method of Endrassic-Grof.
Section 5. Medical science
For identification of the mesenchymal-inflammatory syndrome in the studied patients there was used thymol test sensitive to changes in the lipid contents.
The parameters of the glucose contents (glycemia) in the blood were determined with use of enzymatic-colorimetric method with kits of reagents of Firm "Herbos Dijagnostika" (Croatia).
Concentration of the urea in the blood serum was measured by enzymatic-colorimetric method with kit of reagents NOVOKA.RB of the Manufacture ZAO "Vector-Best" (Russia).
The level of creatinin in the blood serum of the patients was measured with use of pseudokinetic method on the basis of Yaffe
reaction without deproteinization with kit of reagents of the Manufacture OOO "Olvex Diagnosticum" (Russia).
The contents of cholesterol total in the blood serum was determined with enzymatic-colorimetric method with use of reagents of Manufacture OOO "Olvex Diagnosticum" (Russia).
Statistic processing ofthe results obtained was performed on the computer with use of special program EXCEL. The results were considered to be statistic significant in all the used methods at p < 0.05.
Results and discussion. The use of drug Phosphogliv resulted in significant decrease or elimination ofthe clinical symptoms, that contributed to the improvement of the general health state (Table 1).
Table 1. - Occurrence of the clinical symptoms in the patients with HIV-infection associated with viral hepatitis C
Clinical symptoms Studied group Control group
before onset of HAART 1 month after HAART onset Р before onset of HAART 1 month after HAART onset Р
General weakness 87.1 51.3 < 0.05 86.9 73.8 > 0.05
Fatigue 88.8 57.1 < 0.05 93.3 84.1 > 0.05
Insomnia 70.9 65.7 > 0.05 68.7 54.5 > 0.05
Bitter in the mouth 72.2 31.3 < 0.05 70.6 61.9 > 0.05
Poor appetite 95.5 47.1 < 0.05 93.9 85.2 > 0.05
Nausea 27.8 7.10 < 0.05 28.1 21.9 > 0.05
Pains in the right hypochondrium 61.5 24.3 < 0.05 58.7 46.3 > 0.05
Pains in the epigastrium 53.2 20.3 < 0.05 47.8 43.3 > 0.05
Pains in the joints 31.7 27.9 > 0.05 28.5 26.6 > 0.05
Pruritus 43.0 21.0 < 0.05 31.0 29.0 > 0.05
Eruptions 21.0 9.0 < 0.05 19.0 17.0 > 0.05
Sclera yellowness 33.9 15.2 < 0.05 36.3 32.9 > 0.05
Hepathomegalia 31.4 27.6 > 0.05 29.5 28.3 > 0.05
Splenomegalia 19.0 19.0 > 0.05 18.0 18.0 > 0.05
Note: P — reliability of the differences in the values before HAART onset and one month after HAART onset.
The table shows that in the patients of studied group there was revealed a number of statistically reliable changes in comparison with control group; attenuation of the general weakness, fatigue, bitter in the mouth, nausea, pains in the right hypochondrium and epigastrium, yellowness of sclera, pruritus and appetite improvement while there were no reliable differences between groups in relation to such symptoms as insomnia, pains in the joints, hepatomegalia and splenomegalia.
Table 2. - Biochemical parameters in the patients with
With regard to biochemical shifts in the both groups there were found hyperfermentemia and hyperbilirubinemia, as well as disorder of pigment metabolism. The parameters of the contents of the total protein, albumin, cholesterol and glucose in the blood were in normal borders in the majority of patients.
The changes of the biochemical parameters reflecting liver functional state on the background of the application ofvarious methods of treatment presented in table 2.
HIV-infection associated with chronic viral hepatitis C
Studied group Control group
Before 1 month Before 1 month
HAART after HAART Р HAART after HAART Р
onset onset onset onset
Total bilirubin, mcmol/l 39.9 ± 2.1 18.2 ± 1.2 < 0.05 35.6 ± 1.8 33.5 ± 1.5 > 0.05
AlAT, mmol/lA 1.3 ± 0.2 0.41 ± 0.2 < 0.05 1.2 ± 0.2 1.0 ± 0.3 > 0.05
AsAT, mmol/l 0.96 ± 0.2 0.37 ± 0.1 < 0.05 0.95 ± 0.3 0.8 ± 0.3 > 0.05
Total protein, g/l 63.5 ± 2.0 67.3 ± 1.1 > 0.05 65.5 ± 3.1 66.3 ± 3.1 > 0.05
Prothrombin index 67.3 ± 2.1 69.5 ± 2.2 > 0.05 65.3 ± 2.9 66.1 ± 2.5 > 0.05
Creatinin, mcmol/l 142.3 ± 3.3 129.5 ± 3.0 > 0.05 145.6 ± 2.8 140.2 ± 2.5 > 0.05
Urea, mmol/l 7.1 ± 0.5 6.7 ± 0.4 > 0.05 7.3 ± 0.6 7.1 ± 0.5 > 0.05
Thymol test, unit 6.7 ± 0.2 3.7 ± 0.1 < 0.05 6.8 ± 0.3 6.5 ± 0.3 > 0.05
Cholesterol, mmol/l 5.6 ± 0.4 3.9 ± 0.1 < 0.05 5.5 ± 0.7 5.2 ± 0.8 > 0.05
Glucosa in blood mmol/l 5.9 ± 0.3 3.5 ± 0.1 < 0.05 5.4 ± 0.3 5.2 ± 0.3 > 0.05
Alkaline phospatase, ME 297.3 ± 2.6 158.5 ± 2.1 < 0.05 293.8 ± 3.7 279.9 ± 3.4 > 0.05
GGTP, ME/l 65.1 ± 2.2 32.3 ± 1.9 < 0.05 66.2 ± 2.9 57.4 ± 2.4 > 0.05
Note: P — reliability of differences in the biochemical parameters before HAART onset and one month after HAART onset.
Optimization of the surgical treatment for high cicatricle tracheal stenosis
The table shows that at inclusion of the drug Phosphogliv into the basic therapy of patients on the background of HAART the positive dynamics was retraced in the biochemical parameters: there was noted reduction of the total bilirubin contents, activity of the hepatic enzymes — AlAT and AsAT, thymol test, alkaline phosphatase and y-glutamiltranspeptidase (GGTP) There was noted insignificant decrease in the contents of cholesterol and glucose in the blood.
The values of thymol test in the patients of the studied group were reliably reduced (P < 0.05) even to the second week, that was not noted in the control group.
It is necessary to note though on the background of HAART the mean level of the AlAT and AsAT parameters reduced in the patients of control group to the normal values, in 23 % ofpatients in this group after prescription ofART there was noted increase in activity of these enzymes and contents of the total bilirubin in the blood, and in 3 patients there was found marked increase both in activity AlAT and the contents of total bilirubin with predominance of the direct bilirubin. Evidently, it was connected to early unfavorable adverse (hepatotoxic) effect of antiretroviral drugs on the enzymatic and pigment liver function.
Consequently, the use of hepatoprotectors at prescription of HAART for the patients with HIV-infection associated with chronic viral hepatitis C may be considered as rational due to clinical-laboratory efficacy.
Thus, there has been studied efficacy of the drug hepatoprotector "Phosphogliv" in the complex of specific HAART in the patients with HIV-infection associated with chronic viral hepatitis C, and it
has been established that the positive dynamics has been noted as in relation to clinical symptoms (attenuation and/or elimination of clinical expressions of disorders in the hepatobiliary system), so as in the biochemical characteristics, which has been expressed by reduction in the contents of total bilirubin, activity of transaminases, thymol test, AP and GGTP, insignificant reduction of the contents of cholesterol and glucose in the blood. The above-described features indicated about advisability of application of drug Phosphogliv at prescription of HAART in the patients with HIV-infection associated with chronic viral hepatitis C in order to reduce hepatotoxic effect of the used antiretroviral preparations and to contribute to the improvement of the quality of life in the patients by HAART optimization.
Conclusions:
1. Use of drug Phosphogliv on the background of HAART provides for positive effect on the clinical and biochemical parameters, that is expressed by improvement of the general health state, elimination or attenuation of the clinical symptoms and reduction of the level of liver transaminases.
2. Phosphogliv as effective hepatoprotector serves as perspective addition to HAART in the patients with HIV-infection associated with chronic viral hepatitis C.
3. Application of Phosphogliv results in decrease in hepatotoxic manifestations of HAART in HIV+HCV co-infection.
4. The monthly monitoring of the biochemical blood characteristics on the basis of HAART in the patients with HIV-infection associated with chronic viral hepatitis C will allow improvement of the quality of life in these patients.
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Berkinov Ulugbek Bozorbaevich, Professor in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan
Khalikov Sarvar Pulatovich, Assistant in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan E-mail: [email protected]
Optimization of the surgical treatment for high cicatricle tracheal stenosis
Abstract: Benign cicatricle process of the breathing tube is often localized in the subplical area of the larynx and upper trachea and therefore, resection and anastomosis in the upper segment of the respiratory tract represent a separate problem. The
