HIV/HBV Coinfected Patients with Elevated ALT and AST Are at Greater Risk for Liver Disease Progression

		SUMMARY: High levels of the liver enzyme aspartate transaminase (AST) were associated with development of advanced liver disease in HIV positive people with hepatitis B virus (HVB) coinfection, according to a French study published in the January 2010 Journal of Clinical Virology. Patients with normal AST were unlikely to develop severe fibrosis or cirrhosis, in contrast with previous findings for HIV/HCV coinfected individuals.

By Liz Highleyman

Due to overlapping risk factors, many people are coinfected with both HIV and HBV. Research suggests that such individuals tend to experience more rapid liver disease, but the natural history of disease in this population is not fully understood.

P. Sellier and colleagues from France performed a study to characterize liver-related morbidity, mortality, and related risk factors in 107 HIV/HBV coinfected patients. A majority (61%) were from sub-Saharan Africa, while most of the rest (33%) were European. With regard to hepatitis B management, 78% were treated with lamivudine (3TC, Epivir-HBV) and 44% underwent liver biopsies.

The researchers collected clinical, biological, and virological data every 3 months. Liver-related mortality and a composite score were used to define advanced liver disease.

Results

	19 of the 107 patients (18%) were diagnosed with advanced liver disease during a mean follow-up period of 4.8 years:
	10 with extensive fibrosis; 5 with cirrhosis; 3 with hepatocellular carcinoma resulting from cirrhosis; 1 with fulminant hepatitis following lamivudine discontinuation.
	11 patients died overall, 4 of them from HBV-related liver disease.
	In a univariate analysis, factors associated with increased risk of advanced liver disease were male sex, higher mean HIV and HBV viral loads, and elevated levels of alanine and aspartate transaminase (ALT and AST).
	In a multivariate analysis adjusting for other factors, the strongest associations were mean AST level and cumulative time on lamivudine.
	39% of patients with elevated mean AST developed advanced liver disease, compared with just 7% of those with normal mean AST (relative risk 5.5).

"During HIV/HBV coinfection, transaminase levels are strongly associated with advanced liver disease," the study authors wrote. "Normal mean AST has a high negative predictive value, contrary to previously reported data in HIV/HCV patients."

Elevated ALT and AST are biomarkers of liver inflammation, not fibrosis. Other researchers have shown that hepatitis B monoinfected, hepatitis C monoinfected, and HIV/HCV coinfected patients may develop advanced liver damage despite persistently normal ALT levels.

Service de Médecine Interne, Service de Bactériologie - Virologie & Centre d'Informations et de Soins de l'Immunodéficience Humaine, A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Immeuble SCOR, 1, avenue du General de Gaulle, Paris la Défense Cedex, France.

1/19/10

Reference
P Sellier, N Schnepf, I Jarrin, and others. Description of liver disease in a cohort of HIV/HBV coinfected patients. Journal of Clinical Virology 47(1): 13-17 (Abstract). January 2010.