title: Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART.
abstract: BACKGROUND
  Previous studies have demonstrated that hepatitis B virus (HBV) infection increases the risk for ALT elevations in HIV-HBV co-infected patients during the first year of HAART; however, there is limited data on the prevalence of ALT elevations with prolonged HAART in this patient group.
  
  
  RESULTS
  To identify factors associated with ALT elevations in an HIV-HBV co-infected cohort receiving prolonged HAART, data from 143 co-infected patients on HAART enrolled in an international HIV-HBV co-infected cohort where ALT measurements were obtained every 6 months was analysed. A person-visit analysis was used to determine frequency of ALT elevation (≥ 2.5×ULN) at each visit. Factors associated with ALT elevation were determined using multivariate logistic regression with generalized estimating equations to account for correlated data. The median time on HAART at the end of follow-up was 5.6 years (range 0.4-13.3) years. During follow-up, median ALT was 36 U/L with 10.6% of person-visits classified as having ALT elevation. Most ALT elevations were grade 2 (86.5%), with only 13.5% of all ALT elevations grade 3 or higher. Univariate associations with ALT elevation (p<0.05) included history of AIDS, HBV DNA ≥ 2,000 IU/ml, HBeAg positive, study visit CD4 <200 cells/ml and nadir CD4 <200 cells/ml. In the multivariate analysis, only study visit CD4 <200 cells/ml (OR 2.07, 95%CI 1.04-4.11, p = 0.04) and HBeAg positive status (OR 2.22, 95%CI 1.03-4.79, p = 0.04) were independently associated with ALT elevation.
  
  
  CONCLUSIONS
  In this HIV-HBV co-infected cohort, elevated ALT after >1 year of HAART was uncommon, and severe ALT elevations were rare. HIV-HBV co-infected patients on long-term HAART who are either HBeAg positive or have a CD4 count of <200 cells/ml are at increased risk for ALT elevations.
authors: Department of Medicine, Monash University, Melbourne, Australia. jennifer.audsley@monash.edu
authors: Jennifer
authors: J
authors: Audsley
authors: Eric C
authors: EC
authors: Seaberg
authors: Joe
authors: J
authors: Sasadeusz
authors: Gail V
authors: GV
authors: Matthews
authors: Anchalee
authors: A
authors: Avihingsanon
authors: Kiat
authors: K
authors: Ruxrungtham
authors: Kit
authors: K
authors: Fairley
authors: Robert
authors: R
authors: Finlayson
authors: Hyon S
authors: HS
authors: Hwang
authors: Margaret
authors: M
authors: Littlejohn
authors: Stephen
authors: S
authors: Locarnini
authors: Gregory J
authors: GJ
authors: Dore
authors: Chloe L
authors: CL
authors: Thio
authors: Sharon R
authors: SR
authors: Lewin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006678:HIV / Q000502:physiology*; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D006513:Hepatitis B e Antigens / Q000378:metabolism; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D012367:RNA, Viral; D000410:Alanine Transaminase