Author: Mark Mascolini
06 February 2010
High body mass index, heavy alcohol use, a high HIV load, and cumulative use of stavudine (d4T) or zidovudine (AZT) independently raised the risk of elevated alanine aminotransferase (ALT) in Swiss HIV Cohort Study (SHCS) members not coinfected with hepatitis B or C virus (HBV or HCV).
Chronic liver disease in people with HIV can usually be traced to HBV or HCV coinfection. SHCS researchers mounted this study to determine correlates of chronic ALT elevation in cohort members who did not have HBV or HCV. They defined chronic ALT elevation as a level at least twice the upper limit or normal on consecutive semiannual visits from 2002 through 2008.
The study involved 2365 people, 66% of them male, with a median age of 38 years and a median CD4 count of 426 cells/μL; 56% of cohort members were taking antiretrovirals.
Chronic elevated ALT developed in 385 people (16%) for an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI] 3.5 to 4.3). Six variables independently raised the risk of chronically elevated ALT at the following incidence rate ratios (IRR) and 95% CIs:
• HIV RNA above 100,000 copies/mL: IRR 2.23, 95% CI 1.45 to 3.43
• Body mass index 25-29.9 kg/m(2) versus under 25: IRR 1.56, 95% CI 1.24 to 1.95
• Body mass index 30 kg/m(2) or more versus under 25: IRR 1.70, 95% CI 1.16 to 2.51
• Severe alcohol use: IRR 1.83, 95% CI 1.19 to 2.80
• Stavudine use: IRR 1.12 per year, 95% CI 1.07 to 1.17
• Zidovudine use: IRR 1.04 per year, 95% CI 1.00 to 1.08
Black ethnicity halved the risk of chronically elevated ALT (IRR 0.52, 95% CI 0.33 to 0.82). (In the United States, chronic liver disease is the leading cause of death among blacks, according to the US Department of Health and Human Services.)
In the Swiss study, chronic ALT elevation did not affect treatment outcome or mortality during follow-up. But the SHCS team cautions that “long‐term follow‐up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortality.”
Source: Helen Kovari, Bruno Ledergerber, Manuel Battegay, Andri Rauch, Bernard Hirschel, Alain Kenfak Foguena, Pietro Vernazza, Enos Bernasconi, Nicolas J. Mueller, and Rainer Weber, for the Swiss HIV Cohort Study. Incidence and risk factors for chronic elevation of alanine aminotransferase levels in HIV‐infected persons without hepatitis B or C virus co‐infection. Clinical Infectious Diseases. 2010;50:502-511.
For the study abstract
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For the US Public Health Service data