Prevalence and risk factors for abnormal liver stiffness in HIV-infected patients without viral hepatitis coinfection: role of didanosine.
BACKGROUND
Unexpected cases of severe liver disease in HIV-infected patients have been reported and an association with didanosine (ddI) has been suggested. Transient elastography (TE) might detect patients harbouring such a condition. Our objective was to search for the presence of abnormal liver stiffness (LS) in a cohort of HIV-infected patients without HBV or HCV coinfection and to assess the related factors.


METHODS
A cross-sectional prospective study was conducted. LS was assessed by TE in 258 HIV-infected patients without HBV or HCV coinfection and with no evidence of acute hepatotoxicity or other origins of liver disease. LS values > or =7.2 kPa were considered abnormal. Multivariate analyses were performed to identify factors associated with abnormal LS.


RESULTS
Abnormal LS was observed in 29 (11.2%) patients. A total of 18 (16.4%) patients previously treated with ddI and 11 (7.4%) of those who never received ddI had LS values > or =7.2 kPa (P=0.02). The prevalence of abnormal LS was higher in patients previously treated with abacavir than in those who had never received abacavir (15 [21.7%] versus 14 [7.4%]; P=0.001). After multivariate analyses, age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.002-1.1; P=0.004) alcohol intake >50 g/day (AOR 7.2, 95% CI 2.6-19.7; P<0.0001), CD4(+) T-cell count <200 cells/ml (AOR 3.4, 95% CI 1.06-11.007; P=0.03), time on ddI treatment (AOR 1.31, 95% CI 1.12-1.52; P=0.001) and previous abacavir exposure (AOR 3.01, 95% CI 1.18-7.67; P=0.02) were independently associated with abnormal LS.


CONCLUSIONS
The prevalence of abnormal LS in HIV-infected patients without HBV or HCV coinfection is substantial. Long-term exposure to ddI is a major cause of liver damage in these patients.
Merchante
Nicolás
N
Hospital Universitario de Valme, Sevilla, Spain.
Pérez-Camacho
Inés
I
Mira
José A
JA
Rivero
Antonio
A
Macías
Juan
J
Camacho
Angela
A
Gómez-Mateos
Jesús
J
García-Lázaro
Milagros
M
Torre-Cisneros
Julián
J
Pineda
Juan A
JA
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D016049:Didanosine / Q000009:adverse effects*; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D016049:Didanosine