OBJECTIVES: Because liver enzymes elevation (LEE) complicates antiretroviral (ARV) therapy, and because the strongest risk factor for ARV-related LEE is HBV/HCV coinfection, it is speculated that ARV-related LEE may be a form of immune reconstitution disease. This study summarizes the relation between immune reconstitution, ARV-induced LEE, and HBV/HCV coinfection. METHODS: Medical records of ARV-naïve HIV-infected patients initiating ARV were reviewed for hepatitis coinfection, LEE (grade > or =2 AST/ALT) and changes in CD4 T-cell counts over time in an urban HIV clinic. Risk factors for LEE were statistically evaluated, and changes in CD4 T-cell counts were estimated by a mixed-effects linear model. RESULTS: Predictors of LEE included HBV/HCV coinfection (OR = 6.44) and stavudine use (OR = 2.33). Nelfinavir use was protective (OR = 0.45). The mean rate of change in CD4 T-cell counts was higher in HBV/HCV coinfected subjects who developed LEE (99 cells/microL per month) compared with non-coinfected subjects who did not develop LEE (59 cells/microL per month, P = 0.03), non-coinfected subjects who developed LEE (36 cells/microL per month, P =0.01), and coinfected subjects who did not develop LEE, 38% higher (62 cells/microL per month; P =0.11) CONCLUSIONS: A more robust immune restoration was observed among HBV/HCV coinfected subjects who developed liver enzyme elevation after antiretroviral initiation compared with other groups. This finding suggests that ARV-related liver enzyme elevation may be related in part to immune reconstitution, as measured by changes in CD4 T-cell counts.
OBJECTIVES: Because liver enzymes elevation (LEE) complicates antiretroviral (ARV) therapy, and because the strongest risk factor for ARV-related LEE is HBV/HCV coinfection, it is speculated that ARV-related LEE may be a form of immune reconstitution disease. This study summarizes the relation between immune reconstitution, ARV-induced LEE, and HBV/HCV coinfection. METHODS: Medical records of ARV-naïve HIV-infectedpatients initiating ARV were reviewed for hepatitis coinfection, LEE (grade > or =2 AST/ALT) and changes in CD4 T-cell counts over time in an urban HIV clinic. Risk factors for LEE were statistically evaluated, and changes in CD4 T-cell counts were estimated by a mixed-effects linear model. RESULTS: Predictors of LEE included HBV/HCV coinfection (OR = 6.44) and stavudine use (OR = 2.33). Nelfinavir use was protective (OR = 0.45). The mean rate of change in CD4 T-cell counts was higher in HBV/HCV coinfected subjects who developed LEE (99 cells/microL per month) compared with non-coinfected subjects who did not develop LEE (59 cells/microL per month, P = 0.03), non-coinfected subjects who developed LEE (36 cells/microL per month, P =0.01), and coinfected subjects who did not develop LEE, 38% higher (62 cells/microL per month; P =0.11) CONCLUSIONS: A more robust immune restoration was observed among HBV/HCV coinfected subjects who developed liver enzyme elevation after antiretroviral initiation compared with other groups. This finding suggests that ARV-related liver enzyme elevation may be related in part to immune reconstitution, as measured by changes in CD4 T-cell counts.
Authors: J R Arribas; C Ibáñez; B Ruiz-Antoran; J M Peña; C Esteban-Calvo; J Frías; J J Vázquez; J J González-García Journal: AIDS Date: 1998-09-10 Impact factor: 4.177
Authors: M Markowitz; M Conant; A Hurley; R Schluger; M Duran; J Peterkin; S Chapman; A Patick; A Hendricks; G J Yuen; W Hoskins; N Clendeninn; D D Ho Journal: J Infect Dis Date: 1998-06 Impact factor: 5.226
Authors: P Ocama; B Castelnuovo; M R Kamya; G D Kirk; S J Reynolds; A Kiragga; R Colebunders; D L Thomas Journal: Int J STD AIDS Date: 2010-08 Impact factor: 1.359
Authors: Patricia Price; David M Murdoch; Upasna Agarwal; Sharon R Lewin; Julian H Elliott; Martyn A French Journal: Clin Microbiol Rev Date: 2009-10 Impact factor: 26.132
Authors: Ramesh Rengan; Rosemarie Mick; Daniel Pryma; Mark A Rosen; Lilie L Lin; Amit M Maity; Tracey L Evans; James P Stevenson; Corey J Langer; John Kucharczuk; Joseph Friedberg; Susan Prendergast; Tiffany Sharkoski; Stephen M Hahn Journal: J Thorac Oncol Date: 2012-04 Impact factor: 15.609
Authors: Albert M Anderson; Marina B Mosunjac; Melody P Palmore; Melissa K Osborn; Andrew J Muir Journal: World J Gastroenterol Date: 2010-08-28 Impact factor: 5.742
Authors: T J Nagu; M Kanyangarara; C Hawkins; E Hertmark; G Chalamila; D Spiegelman; F Mugusi; W Fawzi Journal: HIV Med Date: 2012-03-14 Impact factor: 3.180
Authors: Brian O Porter; Kara B Anthony; Jean Shen; Barbara Hahn; Chris E Keh; Frank Maldarelli; William C Blackwelder; Henry Clifford Lane; Joseph A Kovacs; Richard T Davey; Irini Sereti Journal: AIDS Date: 2009-01-14 Impact factor: 4.177
Authors: Bruno Bezerril Andrade; Katherine Huppler Hullsiek; David R Boulware; Adam Rupert; Martyn A French; Kiat Ruxrungtham; Marisa Luisa Montes; Huw Price; Pablo Barreiro; Jennifer Audsley; Alan Sher; Sharon R Lewin; Irini Sereti Journal: J Infect Dis Date: 2013-01-18 Impact factor: 5.226