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Abstract Details
Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
Open Forum Infect Dis. 2021 Feb 24;8(3):ofab076. doi: 10.1093/ofid/ofab076.eCollection 2021 Mar.
Shannon Wood1234, Seung Hyun Won35, Hsing-Chuan Hsieh35, Tahaniyat Lalani356, Karl Kronmann36, Ryan C Maves37, Gregory Utz37, Christina Schofield34, Rhonda E Colombo354, Jason F Okulicz38, Jason Blaylock23, Brian K Agan35, Anuradha Ganesan235
Author information
1Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
2Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
3Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
4Division of Infectious Diseases, Madigan Army Medical Center, Tacoma, Washington, USA.
5The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.
6Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
7Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California, USA.
8Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas, USA.
Abstract
Background: As morbidity due to viral coinfections declines among HIV-infected persons, changes in liver-related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated with chronic liver enzyme elevation (cLEE) in HIV-monoinfected patients in the combination antiretroviral therapy (cART) era.
Methods: Participants who were hepatitis B virus and hepatitis C virus seronegative with follow-up after 1996 were included. We defined chronic liver enzyme elevation (cLEE) as alanine aminotransferase elevations ≥1.25 times the upper limit of normal on at least 2 visits, for a duration of ≥6 months within 2 years. We used multivariate Cox proportional hazards models to examine risk factors for cLEE.
Results: Of 2779 participants, 309 (11%) met criteria for cLEE for an incidence of 1.28/100 PYFU (1.28-1.29/100 PYFU). In an adjusted model, cLEE was associated with Hispanic/other ethnicity (reference Caucasian: hazard ratio [HR], 1.744; 95% CI, 1.270-2.395), non-nucleoside reverse transcriptase inhibitor-based cART (reference boosted protease inhibitors: HR, 2.232; 95% CI, 1.378-3.616), being cART naïve (HR, 6.046; 95% CI, 3.686-9.915), or having cART interruptions (HR, 8.671; 95% CI, 4.651-16.164). African American race (HR, 0.669; 95% CI, 0.510-0.877) and integrase strand transfer inhibitor (INSTI)-based cART (HR, 0.222; 95% CI, 0.104-0.474) were protective.
Conclusions: Our findings demonstrate that initiation and continued use of cART are protective against cLEE and support the hypothesis that HIV infection directly impacts the liver. INSTI-based regimens were protective and could be considered in persons with cLEE.