Department of Medicine and Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States of America.
Department of Medicine, University of California, San Francisco, CA, United States of America.
PLoS One. 2021 Jun 1;16(6):e0250368. doi: 10.1371/journal.pone.0250368. eCollection 2021.
Isoniazid preventive therapy (IPT) reduces tuberculosis reactivation and mortality among persons living with HIV (PLWH), yet hepatotoxicity concerns exclude "regular and heavy alcohol drinkers" from IPT. We aimed to determine the prevalence of elevated liver transaminases among PLWH on antiretroviral therapy (ART) who engage in alcohol use.
The Immune Suppression Syndrome Clinic of Mbarara, Uganda.
We defined elevated liver transaminases as ≥1.25 times (X) the upper limit of normal (ULN) for alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST). We evaluated the associations of current alcohol use and other variables of interest (sex, body mass index, and ART regimen) with elevated transaminases at study screening, using multivariable logistic regression to obtain adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Among 1301 participants (53% female, median age 39 years, 67.4% current alcohol use), 18.8% (95% CI: 16.8-21.1) had elevated transaminases pre-IPT, with few (1.1%) severe (≥5X the ULN). The proportion with any elevation among those currently using alcohol and those abstaining was 22.3% and 11.6%, respectively (p<0.01). In multivariable analyses, those currently using alcohol had higher odds of elevated transaminases compared to those abstaining (aOR 1.65, 95% CI 1.15-2.37) as did males compared to females (aOR 2.68, 95% CI 1.90-3.78).
Pre-IPT elevated transaminases among PLWH receiving ART were common, similar to prior estimates, but severe elevations were rare. Current drinking and male sex were independently associated with elevated transaminases. Further research is needed to determine the implications of such transaminase elevations and alcohol use on providing IPT.
异烟肼预防性治疗（IPT）可降低艾滋病毒感染者（PLWH）中结核分枝杆菌再激活和死亡率，但肝毒性问题使“经常且大量饮酒者”无法接受 IPT。我们旨在确定接受抗逆转录病毒治疗（ART）的 PLWH 中，饮酒与肝酶升高的相关性。
乌干达姆巴拉拉的免疫抑制综合征诊所。
我们将肝酶升高定义为丙氨酸氨基转移酶（ALT）和/或天冬氨酸氨基转移酶（AST）超过正常值上限（ULN）的 1.25 倍。我们使用多变量逻辑回归来评估当前饮酒状况和其他感兴趣的变量（性别、体重指数和 ART 方案）与研究筛查时肝酶升高的相关性，以获得调整后的比值比（aOR）和 95%置信区间（CI）。
在 1301 名参与者中（53%为女性，中位年龄 39 岁，67.4%目前饮酒），18.8%（95%CI：16.8-21.1）在 IPT 前出现肝酶升高，其中很少（1.1%）为严重升高（≥5X ULN）。目前饮酒者和不饮酒者中，任何程度肝酶升高的比例分别为 22.3%和 11.6%（p<0.01）。多变量分析显示，与不饮酒者相比，目前饮酒者肝酶升高的可能性更高（aOR 1.65，95%CI 1.15-2.37），男性比女性更可能发生肝酶升高（aOR 2.68，95%CI 1.90-3.78）。
接受 ART 的 PLWH 在接受 IPT 前出现肝酶升高较为常见，与之前的估计相似，但严重升高的情况罕见。目前饮酒和男性性别与肝酶升高独立相关。需要进一步研究以确定这种肝酶升高和饮酒对提供 IPT 的影响。
