Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China

Qin, Fengxiang; Jiang, Junjun; Qin, Chunwei; Huang, Yunxuan; Liang, Bingyu; Xu, Yuyan; Huang, Jiegang; Xu, Zhiliang; Ning, Chuanyi; Liao, Yulin; Zang, Ning; Lai, Jingzhen; Wei, Wudi; Yu, Jun; Li, Ye; Qin, Xionglin; Liang, Hao

doi:10.1136/bmjopen-2018-023140

Cited by 25 publications

(14 citation statements)

References 23 publications

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“…The incidence of liver damage gradually increased to 35% from the initiation of ART to the ninth month of treatment, following which it decreased slightly and fluctuated within the range of 22%-28%. This finding indicates that liver damage was indeed a common event in patients with HIV-1 monoinfection undergoing ART, consistent with the results of recently published studies [19,20]. The incidence of liver damage in our cohort was higher than that reported in other studies, possibly due to the different ULN values for ALT and AST and the definition of liver damage [21,22].…”

Section: Discussionsupporting

confidence: 92%

Incidence of and risk factors for liver damage in patients with HIV‐1 mono‐infection receiving antiretroviral therapy

et al. 2022

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ObjectivesThe study aimed to investigate the incidence of and risk factors for liver damage in patients with human immunodeficiency virus type‐1 (HIV‐1) mono‐infection receiving antiretroviral therapy (ART).MethodsWe retrospectively analyzed the clinical data of patients who were diagnosed with HIV‐1 infection and initiated ART from January to December 2017. Among them, 382 patients with HIV‐1 mono‐infection and normal baseline liver function were included in the analysis. The incidence of liver damage at each follow‐up point, and possible risk factors for liver damage were evaluated via COX regression survival analyses.ResultsThe overall incidence of liver damage (grade I–IV) was 27.23% (interquartile range [IQR]: 26.38%–28.72%). Grade I liver damage was most common and accounted for 22.13% of cases (IQR: 21.06%–24.04%), while grade II liver damage accounted for 3.40% of cases (IQR: 3.19%–4.26%). COX regression and survival analyses revealed that baseline body mass index (BMI), alanine aminotransferase (ALT) level, CD4+ T cell count, HIV‐1 viral load, and the antiretroviral regimen were significantly correlated with the occurrence of liver damage. Moreover, baseline ALT levels and HIV‐1 viral load were identified as independent risk factors for liver damage in patients with HIV‐1 mono‐infection.ConclusionLiver damage is common in patients with HIV‐1 mono‐infection undergoing ART. Patients with risk factors for liver damage should be well‐informed before the initiation of ART, and liver function should be closely monitored during ART even in patients with normal liver function before ART.

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Section: Discussionsupporting

confidence: 92%

Incidence of and risk factors for liver damage in patients with HIV‐1 mono‐infection receiving antiretroviral therapy

et al. 2022

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“…This result agrees with the documented report of Atiba and colleagues that showed no statistically significant differences in plasma AST, ALT and ALP in patients on antiretroviral therapy linked to the duration of treatment (Atiba et al, 9 2021). However, this is not in keeping the report of Qin et al 7 stating that liver damage always exists among HIV infected patients on ART with normal baseline liver function and without HBV/HCV infection (Qin et al, 7 2019), although our result agrees with the fact that cumulative ART duration does not increase the risk of liver damage (Qin et al, 7 2019).…”

Section: Resultscontrasting

confidence: 77%

The pattern of alpha-fetoprotein, CD4+ count, albumin, AST, ALT and ALP in HIV subjects on long term antiretroviral therapy in Nauth Nnewi, Anambra State, Nigeria

Ezeugwunne¹,

Ogbodo²,

Analike³

et al. 2021

IJFCM

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This study determined the pattern of alpha-fetoprotein, CD4 + count, albumin, AST, ALT and ALP in HIV positive subjects on long term antiretroviral therapy in NAUTH Nnewi, Anambra State, Nigeria. A total of ninety six (96) participants who were aged between 18 and 60 years attending the voluntary counseling and testing unit (VCT) and antiretroviral therapy unit (ART) of NnamdiAzikiwe University Teaching Hospital (NAUTH), Nnewi were randomly recruited for the study and grouped based on WHO criteria for HIV staging. Six millilitres (6mls) of blood sample were collected from each of the participants in each group and dispensed into EDTA and plain containers in appropriate volumes for the determination of the alpha fetoprotein (AFP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and CD4+ count using standard laboratory methods. Results revealed no statistically significant differences in mean AFP levels, AST and ALP activities when compared between HIV positive participants on long term ART, short term ART, and HIV positive subjects not on ART and control groups respectively (p>0.05). Serum albumin concentration and ALT was not significantly different in HIV positive participants on long term ART than in those on short term ART (p>0.05) although serum albumin levels were significantly higher in HIV participants on long term ART and short term ART than in HIV positive subjects not on ART in each case (p<0.05) but was significantly lower in HIV positive participants not on ART compared to control subjects (p<0.05). CD4 + count was significantly higher in HIV positive participants on long term ART when compared with those o short term ART and HIV positive participants not on ART respectively (p<0.05). Therefore, this study has shown improved immune recovery with no hepatotoxicity in HIV positive persons on long term duration of antiretroviral therapy. Importantly, hypoalbuminemia existed among HIV positive subjects not on ART which is suggestive of further progression of the disease.

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“…Both the ALP and AST levels show a slight decrease in median from the 1 st to 3rd year of ART therapy. This is in line with a previously reported decrease in liver function markers after the first year with continuous ART use in HIV subjects without co-infection with HBV and HCV (Qin et al, 2019).…”

Section: Discussionsupporting

confidence: 93%

Anti-retroviral therapy and serum protein levels in HIV-1 seropositive patients: a five-year retrospective study

Shedrac

Haruna

Gloria

et al. 2020

Preprint

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Background: Serum proteins designated as liver function biomarkers are used to evaluate patients for hepatic dysfunction. Hepatic effect of Anti-Retroviral Therapy (ART) needs further studies in HIV mono-infected patients. In this study, clinically defined patient datasets were analysed for protein levels in HIV-1 mono-infected seropositive patients with and without ART. Materials and Methods: Data were collected for the study groups, consisting of the control group and HIV-1 mono-infected seropositive patients with and without ART and were analysed statistically for differences among the groups. All subjects in the patient groups attended University of Maiduguri Teaching Hospital, Nigeria for a period of 5 years. Result: The protein levels on initiation of ART were significantly higher than baseline levels (prior to ART). However, continuous use of ART for 5-year period did not induce any further significant change in protein levels. Receiver Operating Characteristic (ROC) curves shows that both Albumin (ALB) and Total protein (TP) levels discriminated among the study groups. The baseline levels of ALB in seropositive patients are significantly lower to levels on initiation of ART. Conclusion: Continuous ART did not cause any further significant change in levels of liver function proteins than was observed on ART initiation. Hence, liver damage on continuous ART is not implied. Both ALB and TP levels could be important in HIV management of patients. Initiation of ART appears to elevate the low ALB level via a yet unknown mechanism and indicates possible role of ALB in ART mechanism of action.

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Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China

Cited by 25 publications

References 23 publications

Incidence of and risk factors for liver damage in patients with HIV‐1 mono‐infection receiving antiretroviral therapy

Incidence of and risk factors for liver damage in patients with HIV‐1 mono‐infection receiving antiretroviral therapy

The pattern of alpha-fetoprotein, CD4+ count, albumin, AST, ALT and ALP in HIV subjects on long term antiretroviral therapy in Nauth Nnewi, Anambra State, Nigeria

Anti-retroviral therapy and serum protein levels in HIV-1 seropositive patients: a five-year retrospective study

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