Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Quebec, Canada.
AIDS. 2019 Jul 1;33(8):1267-1282. doi: 10.1097/QAD.0000000000002233.
: Elevation of liver transaminases is common in patients infected with the HIV. Although this is usually an incidental finding during regular work-up, HIV-infected patients with transaminase elevations require additional visits for laboratory studies and clinical assessments, and often undergo interruptions and changes in antiretroviral therapy (ART). Alanine aminotransferase is present primarily in the liver, thus being a surrogate marker of hepatocellular injury. Aspartate aminotransferase is present in the liver and other organs, namely cardiac and skeletal muscle, kidney and brain. Serum levels of both liver transaminases predict liver-related mortality. Moreover, serum fibrosis biomarkers based on alanine aminotransferase and aspartate aminotransferase predict all-cause mortality. In a busy clinical setting, a diagnostic approach to elevated liver transaminases could be complicated given the frequency and nonspecificity of this finding. Indeed, HIV-infected individuals present multiple risk factors for liver damage and chronic elevation of transaminases, including coinfection with hepatitis B and C viruses, alcohol abuse, hepatotoxicity due to ART, HIV itself and frequent metabolic comorbidities leading to nonalcoholic fatty liver disease. This review provides an update on epidemiology of elevated liver transaminases, summarizes the main etiologic contributors and discusses the prognostic significance and a pragmatic approach to this frequent finding in the clinical practice of HIV medicine. With the aging of the HIV-infected population following the successful implementation of ART in Western countries, liver-related conditions are now a major comorbidity in this setting. As such, clinicians should be aware of the frequency, clinical significance and diagnostic approach to elevated liver transaminases.
肝脏转氨酶升高在感染 HIV 的患者中很常见。虽然这通常是常规检查中的偶然发现，但转氨酶升高的 HIV 感染患者需要额外就诊进行实验室研究和临床评估，并且经常需要中断和改变抗逆转录病毒治疗 (ART)。丙氨酸氨基转移酶主要存在于肝脏中，因此是肝细胞损伤的替代标志物。天冬氨酸氨基转移酶存在于肝脏和其他器官，即心脏和骨骼肌、肾脏和大脑。两种肝转氨酶的血清水平均可预测与肝脏相关的死亡率。此外，基于丙氨酸氨基转移酶和天冬氨酸氨基转移酶的血清纤维化生物标志物可预测全因死亡率。在繁忙的临床环境中，由于这种发现的频率和非特异性，升高的肝脏转氨酶的诊断方法可能会很复杂。事实上，感染 HIV 的个体存在多种导致肝损伤和转氨酶持续升高的危险因素，包括乙型和丙型肝炎病毒合并感染、酗酒、ART 引起的肝毒性、HIV 本身以及导致非酒精性脂肪性肝病的频繁代谢合并症。本文就升高的肝脏转氨酶的流行病学进行了更新，总结了主要的病因，并讨论了这种在 HIV 医学临床实践中常见发现的预后意义和实用方法。随着西方国家成功实施 ART 后感染 HIV 的人群老龄化，肝脏相关疾病现在是该人群中的主要合并症。因此，临床医生应了解升高的肝脏转氨酶的频率、临床意义和诊断方法。
