title: The prevalence and risk factors for abnormal liver enzymes in HIV-positive patients without hepatitis B or C coinfections.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0341, USA. rksterli@hsc.vcu.edu
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Steven
authors.initials: S
authors.lastname: Chiu
authors.forename: Kenny
authors.initials: K
authors.lastname: Snider
authors.forename: Daniel
authors.initials: D
authors.lastname: Nixon
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006679:HIV Seropositivity / Q000201:enzymology*; D006509:Hepatitis B; D006526:Hepatitis C; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase