Primary human immunodeficiency virus infection presenting as elevated aminotransferases

Area of Science:

• Infectious Diseases
• Hepatology
• Virology

Background:

• Primary human immunodeficiency virus type 1 (HIV-1) infection often presents with nonspecific symptoms, leading to delayed diagnosis.
• Elevated aminotransferase levels, indicative of liver enzyme abnormalities, are a known clinical manifestation of primary HIV-1 infection but are infrequently documented.

Purpose of the Study:

• To investigate the occurrence and significance of elevated aminotransferases as a manifestation of primary HIV-1 infection.
• To determine the frequency of elevated aminotransferases in patients diagnosed with primary HIV-1 infection.

Main Methods:

• Retrospective chart review of HIV-1 infected patients diagnosed with primary infection between October 1990 and May 2009.
• Definition of elevated aminotransferase levels as above-normal alanine or aspartate aminotransferase values.
• Analysis of acute hepatitis markers using stored serum samples.

Main Results:

• Primary HIV-1 infection was identified in 2.8% of patients (23/827).
• Elevated aminotransferases were observed in 65.2% of patients with primary HIV-1 infection.
• Common symptoms included fever (95.7%), elevated aminotransferases (65.2%), fatigue (47.8%), and pharyngitis (47.8%).

Conclusions:

• Elevated aminotransferases are a more common initial manifestation of primary HIV-1 infection than previously reported.
• Primary HIV-1 infection should be included in the differential diagnosis for young men presenting with new-onset, unexplained liver function impairment.