title: Pregnancy is associated with elevation of liver enzymes in HIV-positive women on antiretroviral therapy.
abstract: OBJECTIVE
  The objective of this study is to assess whether pregnancy is associated with an increased risk of liver enzyme elevation (LEE) and severe LEE in HIV-positive women on antiretroviral therapy (ART).
  
  
  METHODS
  Two observational studies: the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC).
  
  
  METHODS
  Combined data from UK CHIC and NSHPC were used to identify factors associated with LEE (grade 1-4) and severe LEE (grade 3-4). Women starting ART in 2000-2012 were included irrespective of pregnancy status. Cox proportional hazards were used to assess fixed and time-dependent covariates including pregnancy status, CD4 cell count, drug regimen and hepatitis B virus/hepatitis C virus (HBV/HCV) coinfection.
  
  
  RESULTS
  One-quarter (25.7%, 982/3815) of women were pregnant during follow-up, 14.2% (n = 541) when starting ART. The rate of LEE was 14.5/100 person-years in and 6.0/100 person-years outside of pregnancy. The rate of severe LEE was 3.9/100 person-years in and 0.6/100 person-years outside of pregnancy. The risk of LEE and severe LEE was increased during pregnancy [LEE: adjusted hazard ratio (aHR) 1.66 (1.31-2.09); severe LEE: aHR 3.57 (2.30-5.54)], including in secondary analyses excluding 541 women pregnant when starting ART. Other factors associated with LEE and severe LEE included lower CD4 cell count (<250 cells/μl), HBV/HCV coinfection and calendar year.
  
  
  CONCLUSIONS
  Although few women developed severe LEE, this study provides further evidence that pregnancy is associated with an increased risk of LEE and severe LEE, reinforcing the need for regular monitoring of liver biomarkers during pregnancy.
authors.affiliation: aPopulation, Policy and Practice Programme, UCL Institute of Child Health bHIV Epidemiology and Biostatistics Group, UCL Research Department of Infection and Population Health, London cHuman Development and Health, Faculty of Medicine, University of Southampton, Southampton dHomerton University Hospital NHS Foundation Trust eSection of Retrovirology and GU Medicine, Imperial College, London fAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
authors.forename: Susie
authors.initials: S
authors.lastname: Huntington
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.forename: Teresa
authors.initials: T
authors.lastname: Hill
authors.forename: Pat A
authors.initials: PA
authors.lastname: Tookey
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004798:Enzymes / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000473:pathology*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D004798:Enzymes