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. 2022 Nov;94(11):5451-5464.
doi: 10.1002/jmv.28019. Epub 2022 Aug 15.

Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific

Dhanushi Rupasinghe  1 , Jun Yong Choi  2 , Evy Yunihastuti  3 , Sasisopin Kiertiburanakul  4 , Jeremy Ross  5 , Penh Sun Ly  6 , Romanee Chaiwarith  7 , Cuong Duy Do  8 , Yu-Jiun Chan  9 , Nagalingeswaran Kumarasamy  10 , Anchalee Avihingsanon  11 , Adeeba Kamarulzaman  12 , Suwimon Khusuwan  13 , Fujie Zhang  14 , Man Po Lee  15 , Kinh Van Nguyen  16 , Tuti Parwati Merati  17 , Sashikala Sangle  18 , Ng Oon Tek  19   20   21 , Junko Tanuma  22 , Rossana Ditangco  23 , Benedict Lim Heng Sim  24 , Sanjay Pujari  25 , Awachana Jiamsakul  1 ; TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific
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Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific

Dhanushi Rupasinghe et al. J Med Virol. 2022 Nov.

Abstract

Liver disease is a growing burden among people living with HIV (PLHIV) in resource-limited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82-8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00-5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75-8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23-3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.

Keywords: ALT elevations; Asia-Pacific; HIV; cirrhosis.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflict of interest to disclose.

Figures

Figure 1A:
Figure 1A:
HCV-antibody status
Figure 1B:
Figure 1B:
High alcohol consumption *Not reported/not tested categories were included in the analysis, however, they were not graphically displayed in the figures.
Figure 2A:
Figure 2A:
HCV-antibody status
Figure 2B:
Figure 2B:
HBsAg status *Not reported/not tested categories were included in the analysis, however, they were not graphically displayed in the figures.
See this image and copyright information in PMC

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