Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific

Rupasinghe, Dhanushi and Choi, Jun Yong and Yunihastuti, Evy and Kiertiburanakul, Sasisopin and Ross, Jeremy and Ly, Penh Sun and Chaiwarith, Romanee and Do, Cuong Duy and Chan, Yu-Jiun and Kumarasamy, Nagalingeswaran and Avihingsanon, Anchalee and Kamarulzaman, Adeeba and Khusuwan, Suwimon and Zhang, Fujie and Lee, Man Po and Van Nguyen, Kinh and Merati, Tuti Parwati and Sangle, Sashikala and Tek, Ng Oon and Tanuma, Junko and Ditangco, Rossana and Sim, Benedict Lim Heng and Pujari, Sanjay and Jiamsakul, Awachana (2022) 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, 94 (11). pp. 5451-5464. ISSN 0146-6615, DOI https://doi.org/10.1002/jmv.28019.

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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.

Item Type: Article
Funders: TREAT Asia HIV Observational Database - International Epidemiology Databases to Evaluate AIDS (IeDEA), U01AI069907, Australian Government, Department of Health & Ageing, Ministry of Health-Singapore, National Medical Research Council, Singapore, MOH-000276
Uncontrolled Keywords: ALT elevations; Asia-Pacific; Cirrhosis; HIV
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Medicine Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 24 Nov 2023 01:28
Last Modified: 24 Nov 2023 01:28
URI: http://eprints.um.edu.my/id/eprint/41351

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