title: Acute liver enzyme elevations in HIV-1-infected patients.
abstract: BACKGROUND
  Acute liver enzyme elevations (ALEE) have been associated with a first-line highly active antiretroviral therapy (HAART) and/or viral hepatitis coinfections in HIV-infected patients. By comparison, the frequency and the risk factors of ALEE in untreated patients and in patients treated with several antiretroviral regimens need to be assessed.
  
  
  OBJECTIVE
  To describe the long-term frequency and the characteristics of ALEE in antiretroviral treated and untreated patients and to define risk factors for ALEE in a retrospective cohort of HIV-1-infected patients.
  
  
  METHODS
  An HIV-infected cohort was retrospectively examined. ALEE was defined as levels of alanine amino transferase and/or alkaline phosphatase rising to at least 2.5 times above baseline values. Hazard ratios (HR) for ALEE were estimated using an extension of the Cox proportional model taking into account recurrent events.
  
  
  RESULTS
  Out of 239 assessable patients, 12 (5%) were coinfected with hepatitis B virus (HBV) and 34 (14.2%) with hepatitis C virus (HCV). The incidence rate of ALEE was 9.9/100 patients-year and the cumulative incidence was 20.9%. HCV genotype 3 tended to give a higher risk of ALEE. Independent factors for developing ALEE in multivariate logistic regression were HBV (HR = 4.0) and HCV (HR = 3.4) coinfections, antiretroviral therapy (HR = 2.6), CDC stage C (HR = 2.5), and high alkaline phosphatase baseline values (HR = 1.7).
  
  
  CONCLUSIONS
  The occurrence of ALEE is influenced more by the past medical history and the clinical background of the patients than by antiretroviral therapy. These patient-linked variables must be taken into account to avoid unwarranted treatment withdrawal.
authors: Centre Régional de Pharmacovigilance de Bourgogne, Hôpital Général, CHU Dijon, France.
authors: Claire
authors: C
authors: Livry
authors: Christine
authors: C
authors: Binquet
authors: Catherine
authors: C
authors: Sgro
authors: Marie
authors: M
authors: Froidure
authors: Michel
authors: M
authors: Duong
authors: Marielle
authors: M
authors: Buisson
authors: Michèle
authors: M
authors: Grappin
authors: Catherine
authors: C
authors: Quantin
authors: Henri
authors: H
authors: Portier
authors: Pascal
authors: P
authors: Chavanet
authors: Lionel
authors: L
authors: Piroth
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D015994:Incidence; D008099:Liver / Q000201:enzymology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase