Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART
Previous studies have demonstrated that hepatitis B virus (HBV) infection increases the risk for ALT elevations in HIV-HBV co-infected patients during the first year of HAART; however, there is limited data on the prevalence of ALT elevations with prolonged HAART in this patient group. To identify f...
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| creator | Audsley, Jennifer Seaberg, Eric C Sasadeusz, Joe Matthews, Gail V Avihingsanon, Anchalee Ruxrungtham, Kiat Fairley, Kit Finlayson, Robert Hwang, Hyon S Littlejohn, Margaret Locarnini, Stephen Dore, Gregory J Thio, Chloe L Lewin, Sharon R |
| description | Previous studies have demonstrated that hepatitis B virus (HBV) infection increases the risk for ALT elevations in HIV-HBV co-infected patients during the first year of HAART; however, there is limited data on the prevalence of ALT elevations with prolonged HAART in this patient group.
To identify factors associated with ALT elevations in an HIV-HBV co-infected cohort receiving prolonged HAART, data from 143 co-infected patients on HAART enrolled in an international HIV-HBV co-infected cohort where ALT measurements were obtained every 6 months was analysed. A person-visit analysis was used to determine frequency of ALT elevation (≥ 2.5×ULN) at each visit. Factors associated with ALT elevation were determined using multivariate logistic regression with generalized estimating equations to account for correlated data. The median time on HAART at the end of follow-up was 5.6 years (range 0.4-13.3) years. During follow-up, median ALT was 36 U/L with 10.6% of person-visits classified as having ALT elevation. Most ALT elevations were grade 2 (86.5%), with only 13.5% of all ALT elevations grade 3 or higher. Univariate associations with ALT elevation (p |
| doi_str_mv | 10.1371/journal.pone.0026482 |
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To identify factors associated with ALT elevations in an HIV-HBV co-infected cohort receiving prolonged HAART, data from 143 co-infected patients on HAART enrolled in an international HIV-HBV co-infected cohort where ALT measurements were obtained every 6 months was analysed. A person-visit analysis was used to determine frequency of ALT elevation (≥ 2.5×ULN) at each visit. Factors associated with ALT elevation were determined using multivariate logistic regression with generalized estimating equations to account for correlated data. The median time on HAART at the end of follow-up was 5.6 years (range 0.4-13.3) years. During follow-up, median ALT was 36 U/L with 10.6% of person-visits classified as having ALT elevation. Most ALT elevations were grade 2 (86.5%), with only 13.5% of all ALT elevations grade 3 or higher. Univariate associations with ALT elevation (p<0.05) included history of AIDS, HBV DNA ≥ 2,000 IU/ml, HBeAg positive, study visit CD4 <200 cells/ml and nadir CD4 <200 cells/ml. In the multivariate analysis, only study visit CD4 <200 cells/ml (OR 2.07, 95%CI 1.04-4.11, p = 0.04) and HBeAg positive status (OR 2.22, 95%CI 1.03-4.79, p = 0.04) were independently associated with ALT elevation.
In this HIV-HBV co-infected cohort, elevated ALT after >1 year of HAART was uncommon, and severe ALT elevations were rare. HIV-HBV co-infected patients on long-term HAART who are either HBeAg positive or have a CD4 count of <200 cells/ml are at increased risk for ALT elevations.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0026482</identifier><identifier>PMID: 22069454</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adult ; AIDS ; Alanine Transaminase - blood ; Analysis ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active ; CD4 antigen ; Deoxyribonucleic acid ; Development and progression ; DNA ; DNA, Viral - genetics ; Female ; Health risks ; Hepatitis ; Hepatitis B ; Hepatitis B - blood ; Hepatitis B - drug therapy ; Hepatitis B - virology ; Hepatitis B e antigen ; Hepatitis B e Antigens - metabolism ; Hepatitis B virus - physiology ; Highly active antiretroviral therapy ; HIV ; HIV - physiology ; HIV Infections - blood ; HIV Infections - drug therapy ; HIV Infections - virology ; Human immunodeficiency virus ; Humans ; Identification methods ; Infection ; Interferon ; Longitudinal Studies ; Male ; Mathematical models ; Medical research ; Medicine ; Multivariate analysis ; Patients ; Polymerase Chain Reaction ; Prognosis ; Prospective Studies ; Quality ; Regression analysis ; RNA, Viral - genetics ; Viral Load ; Viruses</subject><ispartof>PloS one, 2011-11, Vol.6 (11), p.e26482-e26482</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Audsley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Audsley et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-56ea3ac19dcb8b0992b8e7d09b80ba25ca0bc540a31dab95f214763f9de687543</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206023/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206023/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22069454$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Audsley, Jennifer</creatorcontrib><creatorcontrib>Seaberg, Eric C</creatorcontrib><creatorcontrib>Sasadeusz, Joe</creatorcontrib><creatorcontrib>Matthews, Gail V</creatorcontrib><creatorcontrib>Avihingsanon, Anchalee</creatorcontrib><creatorcontrib>Ruxrungtham, Kiat</creatorcontrib><creatorcontrib>Fairley, Kit</creatorcontrib><creatorcontrib>Finlayson, Robert</creatorcontrib><creatorcontrib>Hwang, Hyon S</creatorcontrib><creatorcontrib>Littlejohn, Margaret</creatorcontrib><creatorcontrib>Locarnini, Stephen</creatorcontrib><creatorcontrib>Dore, Gregory J</creatorcontrib><creatorcontrib>Thio, Chloe L</creatorcontrib><creatorcontrib>Lewin, Sharon R</creatorcontrib><title>Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Previous studies have demonstrated that hepatitis B virus (HBV) infection increases the risk for ALT elevations in HIV-HBV co-infected patients during the first year of HAART; however, there is limited data on the prevalence of ALT elevations with prolonged HAART in this patient group.
To identify factors associated with ALT elevations in an HIV-HBV co-infected cohort receiving prolonged HAART, data from 143 co-infected patients on HAART enrolled in an international HIV-HBV co-infected cohort where ALT measurements were obtained every 6 months was analysed. A person-visit analysis was used to determine frequency of ALT elevation (≥ 2.5×ULN) at each visit. Factors associated with ALT elevation were determined using multivariate logistic regression with generalized estimating equations to account for correlated data. The median time on HAART at the end of follow-up was 5.6 years (range 0.4-13.3) years. During follow-up, median ALT was 36 U/L with 10.6% of person-visits classified as having ALT elevation. Most ALT elevations were grade 2 (86.5%), with only 13.5% of all ALT elevations grade 3 or higher. Univariate associations with ALT elevation (p<0.05) included history of AIDS, HBV DNA ≥ 2,000 IU/ml, HBeAg positive, study visit CD4 <200 cells/ml and nadir CD4 <200 cells/ml. In the multivariate analysis, only study visit CD4 <200 cells/ml (OR 2.07, 95%CI 1.04-4.11, p = 0.04) and HBeAg positive status (OR 2.22, 95%CI 1.03-4.79, p = 0.04) were independently associated with ALT elevation.
In this HIV-HBV co-infected cohort, elevated ALT after >1 year of HAART was uncommon, and severe ALT elevations were rare. HIV-HBV co-infected patients on long-term HAART who are either HBeAg positive or have a CD4 count of <200 cells/ml are at increased risk for ALT elevations.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>Alanine Transaminase - blood</subject><subject>Analysis</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>CD4 antigen</subject><subject>Deoxyribonucleic acid</subject><subject>Development and progression</subject><subject>DNA</subject><subject>DNA, Viral - genetics</subject><subject>Female</subject><subject>Health risks</subject><subject>Hepatitis</subject><subject>Hepatitis B</subject><subject>Hepatitis B - blood</subject><subject>Hepatitis B - drug therapy</subject><subject>Hepatitis B - virology</subject><subject>Hepatitis B e antigen</subject><subject>Hepatitis B e Antigens - metabolism</subject><subject>Hepatitis B virus - physiology</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV - physiology</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - virology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Infection</subject><subject>Interferon</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Polymerase Chain Reaction</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Quality</subject><subject>Regression analysis</subject><subject>RNA, Viral - genetics</subject><subject>Viral Load</subject><subject>Viruses</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11r2zAUhs3YWD-2fzA2w6BjF071YcvyzSAr6xIIFLost0KWjxMFx0oludv-_eTGLfHoxTDItvSc90ivzomidxhNMM3x5dZ0tpXNZG9amCBEWMrJi-gUF5QkjCD68uj7JDpzbotQRjljr6MTQhAr0iw9jeprqbyxLpbOGaWlhyr-pf0mhgbuH_6mi2Ws21i2YfQQUnptQt54Nl9dzr6uYmUS3dagelaZjbE-Nm3cmHadBHwXz6bT2-Wb6FUtGwdvh_d59PP62_Jqlixuvs-vpotEsQL7JGMgqVS4qFTJS1QUpOSQV6goOSolyZREpcpSJCmuZFlkNcFpzmhdVMB4nqX0PPpw0N03xonBIicwxSh4kRUsEPMDURm5FXurd9L-EUZq8TBh7FpI67VqQNRlDpBzHvZRpSznJUFAEbA0xyjnNQpaX4ZsXbmDSkHrrWxGouOVVm_E2twLGvxHhAaBT4OANXcdOC922iloGtmC6ZwoEMVphkl_sI__kM8fbqDWMuw_XIsJaVWvKabBKM4o4zxQk2eo8FSw0yqUU63D_Cjg8yggMB5--7XsnBPzH7f_z96sxuzFEbsB2fiNM03XV5gbg-kBVNY4Z6F-8hgj0XfDoxui7wYxdEMIe398P09Bj-VP_wIntgMr</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Audsley, Jennifer</creator><creator>Seaberg, Eric C</creator><creator>Sasadeusz, Joe</creator><creator>Matthews, Gail V</creator><creator>Avihingsanon, Anchalee</creator><creator>Ruxrungtham, Kiat</creator><creator>Fairley, Kit</creator><creator>Finlayson, Robert</creator><creator>Hwang, Hyon S</creator><creator>Littlejohn, Margaret</creator><creator>Locarnini, Stephen</creator><creator>Dore, Gregory J</creator><creator>Thio, Chloe L</creator><creator>Lewin, Sharon R</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20111101</creationdate><title>Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART</title><author>Audsley, Jennifer ; Seaberg, Eric C ; Sasadeusz, Joe ; Matthews, Gail V ; Avihingsanon, Anchalee ; Ruxrungtham, Kiat ; Fairley, Kit ; Finlayson, Robert ; Hwang, Hyon S ; Littlejohn, Margaret ; Locarnini, Stephen ; Dore, Gregory J ; Thio, Chloe L ; Lewin, Sharon R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c691t-56ea3ac19dcb8b0992b8e7d09b80ba25ca0bc540a31dab95f214763f9de687543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adult</topic><topic>AIDS</topic><topic>Alanine Transaminase - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Audsley, Jennifer</au><au>Seaberg, Eric C</au><au>Sasadeusz, Joe</au><au>Matthews, Gail V</au><au>Avihingsanon, Anchalee</au><au>Ruxrungtham, Kiat</au><au>Fairley, Kit</au><au>Finlayson, Robert</au><au>Hwang, Hyon S</au><au>Littlejohn, Margaret</au><au>Locarnini, Stephen</au><au>Dore, Gregory J</au><au>Thio, Chloe L</au><au>Lewin, Sharon R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>6</volume><issue>11</issue><spage>e26482</spage><epage>e26482</epage><pages>e26482-e26482</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Previous studies have demonstrated that hepatitis B virus (HBV) infection increases the risk for ALT elevations in HIV-HBV co-infected patients during the first year of HAART; however, there is limited data on the prevalence of ALT elevations with prolonged HAART in this patient group.
To identify factors associated with ALT elevations in an HIV-HBV co-infected cohort receiving prolonged HAART, data from 143 co-infected patients on HAART enrolled in an international HIV-HBV co-infected cohort where ALT measurements were obtained every 6 months was analysed. A person-visit analysis was used to determine frequency of ALT elevation (≥ 2.5×ULN) at each visit. Factors associated with ALT elevation were determined using multivariate logistic regression with generalized estimating equations to account for correlated data. The median time on HAART at the end of follow-up was 5.6 years (range 0.4-13.3) years. During follow-up, median ALT was 36 U/L with 10.6% of person-visits classified as having ALT elevation. Most ALT elevations were grade 2 (86.5%), with only 13.5% of all ALT elevations grade 3 or higher. Univariate associations with ALT elevation (p<0.05) included history of AIDS, HBV DNA ≥ 2,000 IU/ml, HBeAg positive, study visit CD4 <200 cells/ml and nadir CD4 <200 cells/ml. In the multivariate analysis, only study visit CD4 <200 cells/ml (OR 2.07, 95%CI 1.04-4.11, p = 0.04) and HBeAg positive status (OR 2.22, 95%CI 1.03-4.79, p = 0.04) were independently associated with ALT elevation.
In this HIV-HBV co-infected cohort, elevated ALT after >1 year of HAART was uncommon, and severe ALT elevations were rare. HIV-HBV co-infected patients on long-term HAART who are either HBeAg positive or have a CD4 count of <200 cells/ml are at increased risk for ALT elevations.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22069454</pmid><doi>10.1371/journal.pone.0026482</doi><tpages>e26482</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2011-11, Vol.6 (11), p.e26482-e26482 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1310932596 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Acquired immune deficiency syndrome Adult AIDS Alanine Transaminase - blood Analysis Antiretroviral agents Antiretroviral drugs Antiretroviral Therapy, Highly Active CD4 antigen Deoxyribonucleic acid Development and progression DNA DNA, Viral - genetics Female Health risks Hepatitis Hepatitis B Hepatitis B - blood Hepatitis B - drug therapy Hepatitis B - virology Hepatitis B e antigen Hepatitis B e Antigens - metabolism Hepatitis B virus - physiology Highly active antiretroviral therapy HIV HIV - physiology HIV Infections - blood HIV Infections - drug therapy HIV Infections - virology Human immunodeficiency virus Humans Identification methods Infection Interferon Longitudinal Studies Male Mathematical models Medical research Medicine Multivariate analysis Patients Polymerase Chain Reaction Prognosis Prospective Studies Quality Regression analysis RNA, Viral - genetics Viral Load Viruses |
| title | Factors associated with elevated ALT in an international HIV/HBV co-infected cohort on long-term HAART |
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