Abnormal level of hepatic enzymes in HIV population

NATALIA LAUFER; ANA GUN; MARÍA BELÉN BOUZAS; JORGE QUARLERI; GERARDO JUNCOS; MANUEL GOMEZ-CARRILLO; SARA KAUFMAN; HÉCTOR M PEREZ; HORACIO SALOMÓN; PEDRO CAHN

Amsterdam, Holanda

Workshop; Second International Workshop on HIV and Hepatitis Co-infection; 2006

Background: Elevated liver enzyme levels, detected through liver function test, are markers of liver or biliary tract diseases. Alanine aminotransferase (ALT) is a more specific indicator of liver inflammation. In HIV infected patients are a common finding and their diagnosis and management may be difficult. The main goal of this study was to analyze the relationship between elevated ALT and demographics, immunological and virological factors. Methods: In a single clinic, taking care of 2,400 HIV+ patients, 593 consecutive cases, were tested for HBV and HCV markers, after obtaining patient’s consent. Demographics: 65% male; 39.3% heterosexuals, 31%MSM, 12.6% IDU. Diagnostic procedures included: HCV Ab (MEIA and HCV 3.0 Murex), HBV: HBsAg, HBsAb, HBeAg, HBeAb and HBcAb (IgM and total) by MEIA (AXSYM Abbott). ALAT was studied by Bisystem (normal value 41UI/ml) Results:  Overall 41.6% (246) had markers of HBV infection and 20% did so for HCV, 65 cases (11%) showed markers for both viruses. Abnormal ALT was found in 104 (17.5%): 77 (74%) between one to two times over the normal limit, and 27 (26%) two times. Serological markers for HBV (9 chronic carriers, 24 isolated core and 22 resolved HBV) were found in 55 samples, for HCV in 54 samples. Negative results for HBV and HCV markers were found in 26 samples.  Positive HCV RNA PCR was detected in 44 samples, 81.4% subgenotype 1a, no differences in the level of abnormal ALT were seen among different genotypes. Abnormal values of ALT were statistically associated with male gender (probably due to the predominance of viral hepatitis coinfections in this group), chronic HBV coinfection, and HCV coinfection. Isolated HBcAb was associated in the univariable (p=0.0000) analysis but not in the multivariable analysis (p=0.64). Among the group of non coinfected patients, HAART, age, LT CD4+ count and HIV viral load were not statistically associated with abnormal ALT (p=0.59). Neither was the positive HCV RNA PCR in HCV coinfected group (p= 0.18). Conclusions: A high prevalence of HBV and HCV infections was detected.  Abnormal LFTs were frequently found and were associated with chronic viral hepatitis coinfections, male gender. No association with HAART was found but this could be to the low frequency of abnormal Alt in patients without hepatitis coinfections.