Liver enzymes elevation after HAART in HIV-HCV co-infection

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Hepatitis C virus (HCV) co-infection is prevalent in human immunodeficiency virus (HIV) patients.
• The risks and clinical significance of liver enzyme elevation (LEE) following high active antiretroviral therapy (HAART) initiation in this population require further understanding.

Purpose of the Study:

• To determine the incidence and risk factors for liver enzyme elevation (LEE) and hepatotoxicity in HIV-HCV co-infected patients starting HAART.
• To assess the clinical significance of LEE and identify predictive factors for severe hepatotoxicity.

Main Methods:

• Retrospective chart review of 85 HIV-HCV co-infected patients initiating HAART with at least 1 year of follow-up.
• Analysis of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, clinical manifestations, opportunistic infections, and mortality.
• Identification of variables associated with severe hepatotoxicity (grades 3+4 LEE).

Main Results:

• The incidence of severe hepatotoxicity (grades 3+4 LEE) was 4% per person-years.
• No clinical manifestations of liver toxicity were observed, and enzyme levels showed a decreasing trend.
• Higher baseline AST, higher international normalized ratio (INR), and lower albumin were associated with severe hepatotoxicity.
• A baseline AST < 2.1 ULN demonstrated a 92% negative predictive value for severe hepatotoxicity.

Conclusions:

• In HIV-HCV co-infected patients initiating HAART, severe hepatotoxicity is uncommon but associated with specific baseline laboratory values.
• Patients with higher baseline AST, higher INR, and lower albumin are at increased risk for significant transaminase elevations.
• Close monitoring and risk stratification based on baseline parameters are crucial for managing HAART in this vulnerable population.