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Title: Prevalence and Incidence of Liver Dysfunction and Assessment of Biomarkers of Liver Disease in HIV-Infected Asian Children
Authors: Linda Aurpibul
Torsak Bunupuradah
Sam Sophan
David Boettiger
Dewi K. Wati
Lam V. Nguyen
Vonthanak Saphonn
Rawiwan Hansudewechakul
Kulkanya Chokephaibulkit
Pagakrong Lumbiganon
Khanh H. Truong
Viet C. Do
Nagalingeswaran Kumarasamy
Nik K.N. Yusoff
Kamarul Razali
Nia Kurniati
Siew M. Fong
Revathy Nallusamy
Annette H. Sohn
Chiang Mai University
The HIV Netherlands Australia Thailand Research Collaboration
National Pediatric Hospital
University of New South Wales (UNSW) Australia
Universitas Udayana
National Hospital of Pediatrics Hanoi
National Center for HIV/AIDS
University of Health Sciences
Chiangrai Prachanukroh Hospital
Mahidol University
Khon Kaen University
Children's Hospital 1
Children's Hospital 2
YR Gaitonde Centre for AIDS Research and Education
Hospital Raja Perempuan Zainab II
Kuala Lumpur Hospital
University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
Hospital Likas
Penang Hospital
Foundation for AIDS Research
Keywords: Medicine
Issue Date: 22-Jun-2015
Citation: Pediatric Infectious Disease Journal. Vol.34, No.6 (2015), e153-e158
Abstract: © 2015 Wolters Kluwer Health, Inc. All rights reserved. Background: We determined the prevalence and incidence of liver dysfunction before and after initiation of combination antiretroviral therapy (cART) in the TREAT Asia Pediatric HIV Observational Database. Methods: Data from children initiated on cART between 2 and 18 years of age with baseline alanine aminotransferase (ALT) available before and at least once after cART initiation in TREAT Asia Pediatric HIV Observational Database between 2008 and 2012 were analyzed. Prevalence and incidence of liver dysfunction and biomarkers including the aspartate aminotransferase to platelet ratio index and FIB4 index (a noninvasive panel to stage liver disease) were assessed. Results: Data from 1930 children were included. Their median age was 6.9 years; 49% were male; 98% were perinatally infected and 94% were initiated on non-nucleoside reverse transcriptase-based cART regimens. Before cART, the prevalence of ALT ≥3 times the upper limit of normal (×ULN) was 5.8%. There were 8.5% of children with aspartate aminotransferase to platelet ratio index >1.5 (suggestive of liver fibrosis) and 2.7% with FIB4 index >1.3 (predictive of possible cirrhosis). Among the 1143 cases with normal baseline ALT (≤1×ULN), the incidence of ALT 3×ULN after cART was 1.19 of 1000 person-months (95% confidence interval: 0.93-1.51). Two of 350 with available tests (0.6%) met Hy's law (ALT >3×ULN and total bilirubin >2×ULN). By multivariate analysis, baseline hemoglobin <7.5 g/dL was a predictor of ALT >3×ULN, whereas age 5-9 years at cART initiation was protective for liver dysfunction. Conclusions: We demonstrated a low prevalence and incidence of liver dysfunction before and after cART initiation in children with normal baseline chemistries. In this population facing life-long cART, prospective surveillance for emergence of liver disease is warranted.
ISSN: 15320987
Appears in Collections:Scopus 2011-2015

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