Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 183-191, February 2010

Prevalence and Factors Associated With Liver Test Abnormalities Among Human Immunodeficiency Virus–Infected Persons

  • Nancy Crum–Cianflone

      Affiliations

    • HIV Clinic, Naval Medical Center San Diego, San Diego, California
    • Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • Corresponding Author InformationReprint requests Address requests for reprints to: Nancy Crum-Cianflone, MD, MPH, c/o Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, California 92134-1005. fax: (619) 532-8137
    • ,
  • Gary Collins

      Affiliations

    • Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
    • ,
  • Sheila Medina

      Affiliations

    • HIV Clinic, Naval Medical Center San Diego, San Diego, California
    • Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • ,
  • Dean Asher

      Affiliations

    • Radiology Department, Naval Medical Center San Diego, San Diego, California
    • ,
  • Richard Campin

      Affiliations

    • Radiology Department, Naval Medical Center San Diego, San Diego, California
    • ,
  • Mary Bavaro

      Affiliations

    • HIV Clinic, Naval Medical Center San Diego, San Diego, California
    • Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • ,
  • Braden Hale

      Affiliations

    • HIV Clinic, Naval Medical Center San Diego, San Diego, California
    • Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • ,
  • Charles Hames

      Affiliations

    • Gastroenterology Department, Naval Medical Center San Diego, San Diego, California

published online 05 October 2009.

Background & Aims

Liver disease is a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons. We evaluated the prevalence, etiology, and factors associated with liver dysfunction in patients during the highly active antiretroviral therapy era.

Methods

We performed liver tests (baseline and after a 6-month follow-up period) in HIV-infected patients treated at a large clinic. Comprehensive laboratory and ultrasound analyses were performed. Factors associated with liver test abnormalities were assessed using multivariate logistic regression models.

Results

Eighty of 299 HIV-positive patients (27%) had abnormal liver test results during the 6-month study period. The majority of abnormalities were grade 1. Of those with liver test abnormalities, the most common diagnosis was nonalcoholic fatty liver disease (30%), followed by excessive alcohol use (13%), chronic hepatitis B (9%), chronic active hepatitis C (5%), and other (hemochromatosis and autoimmune hepatitis, 2%); 8 participants (10%) had more than 1 diagnosis. In total, 39 HIV patients with abnormal liver test results (49%) had a defined underlying liver disease. Despite laboratory tests and ultrasound examination, 41 abnormal liver test results (51%) were unexplained. Multivariate analyses of this group found that increased total cholesterol levels (odds ratio, 1.6 per 40-mg/dL increase; P = .01) were associated with liver abnormalities.

Conclusions

Liver test abnormalities are common among HIV patients during the highly active antiretroviral therapy era. The most common diagnosis was nonalcoholic fatty liver disease. Despite laboratory and radiologic investigations into the cause of liver dysfunction, 51% were unexplained, but might be related to unrecognized fatty liver disease.

Abbreviations used in this paper: ALT, alanine aminotransferase, AST, aspartate aminotransferase, BMI, body mass index, HAART, highly active antiretroviral therapy, HDL, high-density lipoprotein, HIV, human immunodeficiency virus, IQR, interquartile range, LDL, low-density lipoprotein, NAFLD, nonalcoholic fatty liver disease, NNRTI, nonnucleoside reverse transcriptase inhibitor, NRTI, nucleoside reverse transcriptase inhibitor, OR, odds ratio

 

 Conflicts of interest The authors disclose no conflicts.

 Funding Support for this work was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences, Bethesda, MD. This projected has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-Al-5072.The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH, the Department of Health and Human Services, the DoD, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government.

PII: S1542-3565(09)00993-8

doi:10.1016/j.cgh.2009.09.025

Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 183-191, February 2010