Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e571-e579. doi: 10.1093/cid/ciac708.
We sought to characterize in people with human immunodeficiency virus (PWH) the potential etiologies of elevated alanine aminotransferase (ALT) levels, which are common and often unexplained.
Participants from the longitudinal observational AIDS Clinical Trials Group HAILO cohort without a history of hepatitis C virus (HCV) or hepatitis B virus (HBV) infection nor reported heavy alcohol use were included. Clinical and demographic characteristics, including medication use, the hepatic steatosis index (HSI), and metabolic syndrome (MetS) were compared between participants with and without ALT elevation.
Six hundred sixty-two participants were included; 444 (67%) had ≥1 and 229 (35%) ≥2 consecutive ALT elevations during a median of 4.0 years of follow-up. HSI and Hispanic or other (non-White or Black) race/ethnicity were consistently associated with higher odds of abnormal ALT (odds ratio [OR] 1.1 for HSI as a continuous variable, OR 1.9-2.8 for Hispanic/other race/ethnicity for ≥1 or ≥2 ALT elevations); older age and current smoking were associated with lower odds of abnormal ALT. Associations with metabolic disease, as well as with incident HBV and HCV infection, were strengthened by restricting outcomes to persistent and higher degrees of ALT elevation.
ALT elevation was common in this cohort of PWH and associated with metabolic disease and hepatic steatosis markers. Nonalcoholic fatty liver disease is likely a common cause of liver inflammation in PWH receiving suppressive antiretrovirals, deserving targeted diagnosis and intervention.
我们旨在描述人类免疫缺陷病毒（HIV）感染者中丙氨酸氨基转移酶（ALT）升高的潜在病因，这种情况很常见且常常无法解释。
本研究纳入了来自纵向观察性艾滋病临床治疗试验组 HAILO 队列的参与者，他们均无丙型肝炎病毒（HCV）或乙型肝炎病毒（HBV）感染史，也无报告大量饮酒史。我们比较了 ALT 升高组和非 ALT 升高组参与者的临床和人口统计学特征，包括药物使用、肝脂肪变性指数（HSI）和代谢综合征（MetS）。
本研究共纳入了 662 名参与者；444 名（67%）参与者至少有 1 次 ALT 升高，229 名（35%）参与者至少有 2 次连续的 ALT 升高。在中位随访 4.0 年期间，HSI 和西班牙裔或其他（非白种人或非黑种人）种族/民族与异常 ALT 的可能性更高相关（HSI 作为连续变量的比值比 [OR] 为 1.1，1 次或 2 次 ALT 升高时西班牙裔/其他种族/民族的 OR 为 1.9-2.8）；年龄较大和当前吸烟与异常 ALT 的可能性降低相关。限制 ALT 持续升高和升高程度的结局后，代谢疾病以及乙型肝炎病毒和丙型肝炎病毒感染的发生与 ALT 升高的相关性更强。
在该 HIV 感染者队列中，ALT 升高很常见，与代谢疾病和肝脂肪变性标志物相关。非酒精性脂肪性肝病可能是接受抑制性抗逆转录病毒治疗的 HIV 感染者肝炎症的常见原因，值得进行针对性诊断和干预。
