title: Primary human immunodeficiency virus infection presenting as elevated aminotransferases.
abstract: OBJECTIVE
  Primary human immunodeficiency virus type 1 (HIV-1) infection is often under-diagnosed because of its nonspecific presentations. Elevated aminotransferase levels is one of its clinical manifestations, but is infrequently reported in the literature. The objective of this study was to investigate cases of elevated aminotransferases as a manifestation of primary HIV-1 infection.
  
  
  METHODS
  A retrospective chart review from October 1990 to May 2009 of HIV-1 infected patients in a registered database at a tertiary hospital was conducted to identify patients diagnosed with primary HIV-1 infection. An elevated aminotransferase level was broadly defined as above-normal values of alanine or aspartate aminotransferases. Acute hepatitis markers were determined using stored serum samples.
  
  
  RESULTS
  Twenty-three of the 827 (2.8%) patients were identified as having a primary HIV-1 infection. All were male, with a median age of 26 years (range, 19-77 years), and the majority were men who had sex with men (19/23, 82.6%). The most common clinical manifestations were fever (95.7%), elevated aminotransferases (65.2%), fatigue (47.8%), and pharyngitis (47.8%). The median CD4 lymphocyte count was 374/μL (range, 109-674/μL) and the median log HIV viral load was 5.0 (range, 4.3-5.9). For the 15 patients with abnormal liver function tests, the median aspartate aminotransferase level was 112 U/L (range, 62-969 U/L) and the median alanine aminotransferase level was 146 U/L (range, 42-1,110 U/L).
  
  
  CONCLUSIONS
  Elevated aminotransferases may be an initial manifestation of primary HIV infection and is more common than expected. Primary HIV-1 infection should be one of the differential diagnoses considered in young men presenting with unexplained, new-onset liver function impairment.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yi-Jan
authors.initials: YJ
authors.lastname: Chen
authors.forename: Hung-Chin
authors.initials: HC
authors.lastname: Tsai
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Cheng
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D005221:Fatigue / Q000150:complications; D005334:Fever / Q000150:complications; D015658:HIV Infections / Q000175:diagnosis* / Q000201:enzymology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000150:complications; D019562:Viral Load
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase