Alterations in immune function are associated with liver enzyme elevation in HIV and HCV co-infection after commencement of combination antiretroviral therapy.

The cause of liver enzyme elevation during combination antiretroviral therapy in people with human immunodeficiency virus and hepatitis C virus co-infection is unclear. We followed 12 subjects (five with alanine transaminase elevation) for 24 weeks after combination antiretroviral therapy commencement. Immune responses against hepatitis C virus, human immunodeficiency virus and other viruses were assessed by interferon-γ ELISpot. Plasma cytokines, chemokines and anti-hepatitis C virus antibody levels were measured. Those with liver enzyme elevation had higher ELISpot responses both against hepatitis C virus non-structural regions and other viral antigens, and their anti-hepatitis C virus antibody levels were consistently higher, suggesting that reconstitution of both hepatitis C virus-specific and non-hepatitis C virus-specific immune responses may be associated with liver transaminase elevation during combination antiretroviral therapy.

To routinely offer testing for HIV infection in all cases of tuberculosis: a rational clinical approach?

The strong interaction between the HIV and tuberculosis epidemics has been well described. Australian national surveillance data suggest that HIV status is ascertained by clinicians in less than 50% of people with tuberculosis. Clinicians are not able to reliably predict which people have HIV infection - risk factor assessment alone is insufficient. Because tuberculosis is an AIDS-defining condition and highly effective therapy for HIV infection is available, all patients with Mycobacterium tuberculosis infection should be offered HIV testing.