Is the increased risk of liver enzyme elevation in patients co-infected with HIV and hepatitis virus greater in those taking antiretroviral therapy?

Abstract

OBJECTIVES:

To investigate if the risk of liver enzyme elevation (LEE) in HIV/hepatitis B or C (HBV, HCV) co-infection is altered by HAART (two or more drugs).

METHODS:

Analysis comprised HIV-positive patients in the ICoNA study without acute hepatitis who had >or= 1 positive HCV antibody test and > 1 positive HBV surface antigen test. LEE was defined as > 5x baseline alanine aminotransferase (ALT) or > 3.5x baseline if the baseline was > 40 IU/l. Analysis used Poisson regression with generalized estimating equation correction to examine HBV or HCV co-infection, use of HAART, baseline ALT and demographics as LEE predictors.

RESULTS:

Of the 5272 patients, 47.6% were co-infected with HCV/HBV; 29.9% were female and 39% were intravenous drug users. There were 275 episodes of LEE during 18 259 person-years follow up. Taking HAART did not significantly increase risk of LEE [adjusted relative risk (RR), 1.19; 95% confidence interval (CI), 0.81-1.75; P = 0.37]. Co-infection increased the risk of LEE (adjusted RR, 5.07; 95% CI, 3.47-7.48; P < 0.001), with no significant differences if taking HAART (adjusted RR, 4.99; 95% CI, 3.38-7.37) or not (adjusted RR, 6.02; 95% CI, 2.02-17.98) (P = 0.74 for interaction). Females were at lower risk of LEE than males (adjusted RR, 0.59; 95% CI, 0.42-0.83; P = 0.02).

CONCLUSIONS:

HIV and HBV/HCV co-infection per se is associated with increased risk of LEE that is not modified by HAART. The recommendation for caution in HAART use in co-infected patients, simply based on a high rate of LEE in people on therapy, may be questionable.

• Authors: Paola Cicconi, Alessandro Cozzi-Lepri, Andrew Phillips, Massimo Puoti, Giorgio Antonucci, Paolo E Manconi, Giulia Tositti, Vincenzo Colangeli, Miriam Lichtner, Antonella d'arminio Monforte, ICoNA Study Group
• Journal: AIDS (London, England) (AIDS) Vol. 21 Issue 5 Pg. 599-606 (Mar 12 2007) ISSN: 0269-9370 [Print] England
• PMID: 17314522 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Alanine Transaminase

Topics

• Adult
• Alanine Transaminase (blood)
• Anti-HIV Agents (adverse effects)
• Antiretroviral Therapy, Highly Active (adverse effects)
• Female
• Follow-Up Studies
• HIV Infections (complications, drug therapy, enzymology)
• Hepatitis B, Chronic (complications, enzymology)
• Hepatitis C, Chronic (complications, enzymology)
• Humans
• Liver (drug effects, enzymology)
• Male
• Risk Assessment