Elevated Aspartate Aminotransferase-to-Platelet Ratio Index in Perinatally HIV-Infected Children in the United States

Abstract

Elevated aspartate aminotransferase-to-platelet ratio index (APRI) may signal liver fibrosis. Among 397 US children with perinatal HIV infection, APRI at baseline was > 1.5 in 0.8% (95% confidence interval [CI], 0.2–2.2%) and > 0.5 in 6.5% (95%CI, 4.3–9.4%); incidence on study was 0.5 (95%CI, 0.2–1.2) and 6.4 (95%CI, 4.8–8.3) per 100 person-years, respectively. Long-term liver outcomes after perinatal HIV infection warrant further study.

Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth

“…Congruent with our above findings, the prevalence of evidence of at least mild to moderate fibrosis or worse (APRI > 0.5 or FIB-4 >1.45) was also consistently higher among HIV infected participants compared to their uninfected counterparts, though only statistically significant for APRI. Our prevalence rate of APRI >0.5 and >1.5 was 10% and 2%, respectively which was comparable to another domestic study of HIV-infected children whose rates were 6.5% and 0.8%[33], respectively and slightly lower compared to a Latin American study of HIV-infected children whose rate of APRI > 1.5 was 3.2%[32]. The smaller evaluable sample for FIB-4 showed a similar trend that did not achieve statistical significance.…”

“…Few studies have evaluated the incidence of progression of non-invasive markers of liver disease over time[29, 33] and only one was in HIV-infected children. This pediatric study only evaluated APRI and, while their rate of progression to an APRI > 0.5 was comparable to ours, that of APRI >1.5, which is suggestive of significant and advanced fibrosis, was almost 3-fold higher among our cohort.…”

“…Non-invasive markers of liver disease such as the Fibrosis-4 (FIB-4) score [based on the serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), the platelet count and patient age] and the AST-to-platelet ratio index (APRI), have both been validated for identifying liver fibrosis and cirrhosis in adults with viral hepatitis[23–31]. While experience with these makers is extensive in adults, only a single study has compared APRI and liver biopsy in children[28] and there is little experience with these markers in children with HIV infection[32, 33]. …”

Prevalence and Incidence of Liver Dysfunction and Assessment of Biomarkers of Liver Disease in HIV-Infected Asian Children

“…In this study we found 8.5% of children had an APRI >1.5 pre-cART, with an incidence of 0.77 per 1000 person-months among those with a normal baseline ALT after starting treatment. Our baseline prevalence and incidence of elevated APRI after cART were higher than the levels reported in a perinatally HIV-infected US pediatric cohort (i.e., 0.8% and 0.5 per 100 persons-years, respectively) [13]. Our median APRI (0.34, IQR 0.18–0.63) was slightly higher than that reported from an observational cohort of 1012 children with HIV at a median age 5.4 years from five Latin-American countries (0.29, range 0.05–29.67) [12].…”

“…Combination biomarkers such as the aspartate aminotransferase (AST)/ALT ratio, AST-to-platelet ratio index (APRI) and FIB4 index, have been reported as potentially useful for predicting hepatic fibrosis in children with non-alcoholic fatty liver disease [9], chronic viral hepatitis [10], chronic liver disease from various etiologies [11], as well as among perinatally HIV-infected Latin-American children [12]. A recent US study has reported low level APRI elevations prior to cART, with increasing levels over time on ART in perinatally HIV-infected children [13]. …”