Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific
Issued Date
2022-11-01
Resource Type
ISSN
01466615
eISSN
10969071
Scopus ID
2-s2.0-85136124877
Pubmed ID
35869413
Journal Title
Journal of Medical Virology
Volume
94
Issue
11
Start Page
5451
End Page
5464
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Medical Virology Vol.94 No.11 (2022) , 5451-5464
Suggested Citation
Rupasinghe D., Choi J.Y., Yunihastuti E., Kiertiburanakul S., Ross J., Ly P.S., Chaiwarith R., Do C.D., Chan Y.J., Kumarasamy N., Avihingsanon A., Kamarulzaman A., Khusuwan S., Zhang F., Lee M.P., Van Nguyen K., Merati T.P., Sangle S., Oon Tek N., Tanuma J., Ditangco R., Sim B.L.H., Pujari S., Jiamsakul A. Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific. Journal of Medical Virology Vol.94 No.11 (2022) , 5451-5464. 5464. doi:10.1002/jmv.28019 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/84882
Title
Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific
Author's Affiliation
National Centre for Infectious Diseases
Lee Kong Chian School of Medicine
The Voluntary Health Services, Chennai
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
The Kirby Institute
National Center for Global Health and Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
B.J. Medical College, Pune
Tan Tock Seng Hospital
Research Institute of Tropical Medicine
National Hospital for Tropical Diseases
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
National Center for HIV/AIDS
Research Institute for Health Sciences
Lee Kong Chian School of Medicine
The Voluntary Health Services, Chennai
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
The Kirby Institute
National Center for Global Health and Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
B.J. Medical College, Pune
Tan Tock Seng Hospital
Research Institute of Tropical Medicine
National Hospital for Tropical Diseases
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
National Center for HIV/AIDS
Research Institute for Health Sciences
Other Contributor(s)
Abstract
Liver disease is a growing burden among people living with HIV (PLHIV) in resource-limited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82–8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00–5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75–8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23–3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.