Patients with HIV infection should be screened routinely for chronic liver disease if their alanine aminotransferase (ALT) levels are elevated, according to a study published in AIDS Care.
“In HIV-positive individuals, liver disease (mostly due to hepatitis B and C virus [HBV and HCV]) is the third most common cause of mortality after AIDS-related illness and non-AIDS nonviral malignancy,” wrote Sumita Verma, MD, of Brighton and Sussex (U.K.) University Hospital, and her coauthors. “Our aim therefore was to assess prevalence, aetiology, and predictors of nonviral-related chronic liver disease (CLD) in a cohort with HIV monoinfection.”
Brighton and Sussex Medical School
Dr. Sumita Verma
Investigators recruited 3,872 HIV-positive subjects from a Southeast England teaching hospital between 2005 and 2012, of whom 1,654 (42.7%) were found to be at least two ALT levels above the upper limit of normal. Clinically significant CLD was classified as having at least F2 fibrosis (metavir scoring) on liver biopsy, having a liver stiffness measurement greater than F2 (metavir) on a transient elastography, moderate to severe hepatic steatosis on a liver biopsy, a portal hypertension that was either cirrhotic or noncirrhotic, hepatic decompensation, a liver-related mortality, or any combination of these factors. (AIDS Care. 2016 Ju 5. doi: 10.1080/09540121.2016.1191603)
Of the 1,654 subjects with HIV and elevated ALT levels, 1,047 (27.0%) had elevated ALT levels when tested again after 6 months, with 243 of those (23.2%) having a further radiologic or histologic examination done. The final cohort comprised 222 subjects, of which CLD was found in 147 (66.2%), while only 75 (33.8%) had no CLD despite having elevated ALT and HIV. CLD was determined to be “clinically significant” in one out of every four subjects who had it.
“Potential risk factors for CLD included alcohol use (44.2%), one or more feature of the [metabolic syndrome] (68%) and [antiretroviral] use (74.1%), with 68.7% having [more than one] risk factor [and] serum triglyceride (odds ratio, 1.482; 95% confidence interval. 1.053-2.086; P = .024) was the only independent predictor of CLD,” the investigators noted.
Furthermore, the study shows that “the most striking observation [is] that only 23% with persistently elevated ALT were investigated further, with only 58/1,047 (5.5%) undergoing objective assessment of hepatic fibrosis and 45/1,047 (4.3%) being referred to Hepatology.”
Dr. Verma and her coauthors did not report any relevant financial disclosures.