TLR7 Gene Effect on Hepatic Fibrosis Progression Rate in HIV-infected Patients with Chronic Hepatitis C

The aim of the research – to optimize the prediction of hepatic fibrosis (HF) progression rate in HIV-infected patients with chronic hepatitis C (CHC) based on a comprehensive assessment of general clinical, biochemical, immunological and molecular-genetic markers. Materials and methods. A cross-sectional cohort study was conducted, which included 104 HIV-infected patients with CHC. The examination program included: assessment of complaints and anamnestic data obtained by questioning and detailed analysis of medical records, physical examination, general clinical study of peripheral blood, determination of biochemical parameters of blood serum, characterizing the functional state of the liver, the level of СD4+ Т-lymphocytes, the stages of HF according to METAVIR and genetic studies (genotyping of TLR7 in order to determine the carriage of Leu allele). Results. The method of discriminant analysis showed that statistically significant informative diagnostic signs of the rapid rate of HF progression in HIV-infected patients with CHC are: lymphocytosis, the levels of AST and total bilirubin exceeding the upper limit of normal, among the concomitant pathology ‒ chronic cholecystitis, chronic pancreatitis, cholelithiasis and hepatic steatosis, the baseline level of СD4+ Т-lymphocytes less than 350 cells/mm3 and a carriage of the normal genotype (Gln/Gln, Gln/-) of the TLR7 gene. In order to optimize the prognostication of the affiliation of an HIV-infected patient with CHC to the risk group of HF rapid progression there was proposed a discriminant model of 5 risk factors (the normal genotype (Gln/Gln, Gln/-) of the TLR7 gene, the levels of total bilirubin and AST exceeding the upper limit of normal, lymphocytosis, the baseline level of СD4+ Т-lymphocytes less than 350 cells/mm3), the exact prognosis of which was 75 %. Conclusions. There was proposed an effective model that allows predicting a rapid rate of HF progression in HIV-infected patients with CHC on the basis of simple characteristics, most of which are used in routine clinical practice.