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Incidence and Risk Factors for Chronic Elevation of Alanine Aminotransferase Levels in HIV-Infected Persons without Hepatitis B or C Virus Co-Infection

Kovari, Helen ; Ledergerber, Bruno ; Battegay, Manuel ; Rauch, Andri ; Hirschel, Bernard ; Foguena, Alain Kenfak ; Vernazza, Pietro ; Bernasconi, Enos ; Mueller, Nicolas J. ; Weber, Rainer

In: Clinical Infectious Diseases, 2010, vol. 50, no. 4, p. 502-511

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    Titre
    • Incidence and Risk Factors for Chronic Elevation of Alanine Aminotransferase Levels in HIV-Infected Persons without Hepatitis B or C Virus Co-Infection
    Auteur
    • Kovari, Helen. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Basel
    • Ledergerber, Bruno. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Basel
    • Battegay, Manuel. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel
    • Rauch, Andri. University Clinic of Infectious Diseases, University Hospital Berne and University of Berne, Berne
    • Hirschel, Bernard. Division of Infectious Diseases, University Hospital, Geneva
    • Foguena, Alain Kenfak. Division of Infectious Diseases, University Hospital, Lausanne
    • Vernazza, Pietro. Division of Infectious Diseases, Cantonal Hospital, St. Gall
    • Bernasconi, Enos. Ospedale Regionale, Lugano, Switzerland
    • Mueller, Nicolas J.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Basel
    • Weber, Rainer. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Basel
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Clinical Infectious Diseases, 2010, vol. 50, no. 4, p. 502-511. The University of Chicago Press
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:294484
    Summary
    Background. Chronic liver disease in human immunodeficiency virus (HIV)-infected patients is mostly caused by hepatitis virus co-infection. Other reasons for chronic alanine aminotransferase (ALT) elevation are more difficult to diagnose. Methods. We studied the incidence of and risk factors for chronic elevation of ALT levels (greater than the upper limit of normal at ⩾2 consecutive semi-annual visits) in participants of the Swiss HIV Cohort Study without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who were seen during the period 2002-2008. Poisson regression analysis was used. Results. A total of 2365 participants were followed up for 9972 person-years (median age, 38 years; male sex, 66%; median CD4+ cell count, 426/µL; receipt of antiretroviral therapy [ART], 56%). A total of 385 participants (16%) developed chronic elevated ALT levels, with an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI], 3.5-4.3 cases per 100 person-years). In multivariable analysis, chronic elevated ALT levels were associated with HIV RNA level >100,000 copies/mL (incidence rate ratio [IRR], 2.23; 95% CI, 1.45-3.43), increased body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) (BMI of 25-29.9 was associated with an IRR of 1.56 [95% CI, 1.24-1.96]; a BMI ⩾30 was associated with an IRR of 1.70 [95% CI, 1.16-2.51]), severe alcohol use (1.83 [1.19-2.80]), exposure to stavudine (IRR per year exposure, 1.12 [95% CI, 1.07-1.17]) and zidovudine (IRR per years of exposure, 1.04 [95% CI, 1.00-1.08]). Associations with cumulative exposure to combination ART, nucleoside reverse-transcriptase inhibitors, and unboosted protease inhibitors did not remain statistically significant after adjustment for exposure to stavudine. Black ethnicity was inversely correlated (IRR, 0.52 [95% CI, 0.33-0.82]). Treatment outcome and mortality did not differ between groups with and groups without elevated ALT levels. Conclusions. Among patients without hepatitis virus co-infection, the incidence of chronic elevated ALT levels was 3.9 cases per 100 person-years, which was associated with high HIV RNA levels, increased BMI, severe alcohol use, and prolonged stavudine and zidovudine exposure. Long-term follow-up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortality