Digestive Diseases and Sciences

, Volume 53, Issue 5, pp 1375–1382

The Prevalence and Risk Factors for Abnormal Liver Enzymes in HIV-Positive Patients without Hepatitis B or C Coinfections

  • Richard K. Sterling
  • Steven Chiu
  • Kenny Snider
  • Daniel Nixon
Original Paper

DOI: 10.1007/s10620-007-9999-6

Cite this article as:
Sterling, R.K., Chiu, S., Snider, K. et al. Dig Dis Sci (2008) 53: 1375. doi:10.1007/s10620-007-9999-6

Abstract

Background Abnormal liver enzymes (LFTs) are frequently seen in HIV patients. Because HCV and HBV overshadow other possible variables, little is known about the prevalence and predictive factors of abnormal LFTs in the absence of viral hepatitis. Aims To determine the prevalence and factors associated with abnormal LFTs defined as >1.25 ULN. Methods A retrospective analysis of HIV clinic patients was performed. Variables were determined at the time of abnormal LFTs or by history and included diabetes mellitus (DM), hypertension (HTN), dyslipidemia, HCV and HBV status, metabolic syndrome (MS), and HAART use (NRTI, NNRTI, and PI). Results Patients without HCV/HBV (n = 679/1,208) were younger, Caucasian, had a BMI >30 and had dyslipidemia. The prevalences of elevated LFTs in those without HCV/HBV were AST 20%, ALT 15%, and ALP 43% compared to 64%, 46%, and 63% in those with HCV (all P < 0.0001), and 98% were mild-moderate (grade 1–2). While AST was highly correlated with ALT, neither was associated with increased ALP. In those without HCV/HBV, increased AST was associated with HTN, HIV RNA, and absence of PI use; increased ALT was associated with HTN, HIV RNA, CD4 < 200, MS, and absence of PI use, while increased ALP was associated with age, BMI, CD4%, DM, and NRTI use. Conclusions Mild-moderate increased liver enzymes are common in HIV patients without HCV/HBV and absence of PI use is independently associated with elevations in both AST and ALT, while features typical of hepatic steatosis (DM and BMI) are only associated with increased ALP.

Keywords

Abnormal liver enzymesHIV infection

Abbreviations

LFTs

Liver function tests

HIV

Human immunodeficiency virus

HCV

Hepatitis C virus

HBV

Hepatitis B virus

ULN

Upper limits of normal

DM

Diabetes mellitus

IR

Insulin resistance

HTN

Hypertension

MS

Metabolic syndrome

HAART

Highly active antiretroviral therapy

NRTI

Nucleoside/tide reverse transcriptase inhibitor

NNRTI

Non-nucleoside reverse transcriptase inhibitor

PI

Protease inhibitor

RNA

Ribonucleic acid

BMI

Body mass index

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

ALP

Alkaline phosphatase

MLR

Multivariate logistic regression

AZT

Zidovudine

LAM

Lamivudine

ddI

Didanosine

d4T

Stavudine

FTC

Emtricitobine

ABAC

Abacavir

EFV

Efavirenz

NVP

Nevirapine

LOP

Lopinavir

NEL

Nelfinavir

AMP

Amprinavir

ATZ

Atazanavir

RIT

Ritonavir

IND

Indinavir

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Richard K. Sterling
    • 1
    • 4
  • Steven Chiu
    • 2
  • Kenny Snider
    • 3
  • Daniel Nixon
    • 4
  1. 1.Division of Gastroenterology, Hepatology, and NutritionVirginia Commonwealth University Medical CenterRichmondUSA
  2. 2.Virginia Commonwealth University School of MedicineVirginia Commonwealth University Health SystemRichmondUSA
  3. 3.Department of PharmacyVirginia Commonwealth University Health SystemRichmondUSA
  4. 4.Division of Infectious DiseaseVirginia Commonwealth University Health SystemRichmondUSA