title: Elevated alanine aminotransferase levels in HIV-infected persons without hepatitis B or C virus coinfection.
abstract: BACKGROUND
  Mortality related to human immunodeficiency (HIV) has improved with the use of antiretroviral therapy; however, liver disease-related mortality remains a major concern for the HIV population. Elevation of alanine aminotransferase (ALT) has been noted in HIV-infected persons even without viral hepatitis infection.
  
  
  OBJECTIVE
  The objective of this study was to determine the incidence and prevalence of chronic alanine ALT elevation among patients infected with HIV who are negative for hepatitis B or C infection.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  We reviewed the medical records of all patients infected with HIV who had been treated from November 2002 to December 2010.
  
  
  METHODS
  Patients with an unknown or positive HBV or HCV infection status were excluded. We identified patient demographics, route of transmission, peak viral load, and nadir CD4 count.
  
  
  RESULTS
  We followed 440 patients for up to 2265 person-years. A total of 123 patients developed chronically elevated ALT levels, with an incidence of 5.8 cases per 100 person-years. Chronically elevated ALT levels were associated with high HIV viral load, mean body mass index, and diabetes mellitus. We found exposure to lamivudine in 58% of the patients, efavirenz in 41%, and zidovudine in 38%. Abdominal ultrasounds revealed fatty liver in 20 of 39 (51%) of the patients.
  
  
  CONCLUSIONS
  Among patients without viral hepatitis coinfection, the prevalence and incidence of chronic elevated ALT levels were high and accompanied by high HIV RNA levels and increased BMI.
  
  
  CONCLUSIONS
  The limitations of this report are its retrospective nature and lack of a control group.
authors.affiliation: Dr. Saad Alghamdi, Department of Medicine,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, ssaad3131@hotmail.com, ORCID: http://orcid.org/0000-0001-7693-7201.
authors.forename: Saad
authors.initials: S
authors.lastname: Alghamdi
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alrbiaan
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alhuraiji
authors.affiliation: Dr. Saad Alghamdi, Department of Medicine,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, ssaad3131@hotmail.com, ORCID: http://orcid.org/0000-0001-7693-7201.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alghamdi
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Alrajhi
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use; D048588:Benzoxazines / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D060085:Coinfection; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000276:immunology; D006509:Hepatitis B / Q000097:blood; D006526:Hepatitis C / Q000097:blood; D006801:Humans; D015994:Incidence; D019259:Lamivudine / Q000627:therapeutic use; D008107:Liver Diseases / Q000097:blood* / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D015215:Zidovudine; D000410:Alanine Transaminase; C098320:efavirenz