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Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era

BACKGROUND: As morbidity due to viral coinfections declines among HIV-infected persons, changes in liver-related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated wit...

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Autores principales: Wood, Shannon, Won, Seung Hyun, Hsieh, Hsing-Chuan, Lalani, Tahaniyat, Kronmann, Karl, Maves, Ryan C, Utz, Gregory, Schofield, Christina, Colombo, Rhonda E, Okulicz, Jason F, Blaylock, Jason, Agan, Brian K, Ganesan, Anuradha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953661/
https://www.ncbi.nlm.nih.gov/pubmed/33738323
http://dx.doi.org/10.1093/ofid/ofab076
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author Wood, Shannon
Won, Seung Hyun
Hsieh, Hsing-Chuan
Lalani, Tahaniyat
Kronmann, Karl
Maves, Ryan C
Utz, Gregory
Schofield, Christina
Colombo, Rhonda E
Okulicz, Jason F
Blaylock, Jason
Agan, Brian K
Ganesan, Anuradha
author_facet Wood, Shannon
Won, Seung Hyun
Hsieh, Hsing-Chuan
Lalani, Tahaniyat
Kronmann, Karl
Maves, Ryan C
Utz, Gregory
Schofield, Christina
Colombo, Rhonda E
Okulicz, Jason F
Blaylock, Jason
Agan, Brian K
Ganesan, Anuradha
author_sort Wood, Shannon
collection PubMed
description BACKGROUND: As morbidity due to viral coinfections declines among HIV-infected persons, changes in liver-related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated with chronic liver enzyme elevation (cLEE) in HIV-monoinfected patients in the combination antiretroviral therapy (cART) era. METHODS: Participants who were hepatitis B virus and hepatitis C virus seronegative with follow-up after 1996 were included. We defined chronic liver enzyme elevation (cLEE) as alanine aminotransferase elevations ≥1.25 times the upper limit of normal on at least 2 visits, for a duration of ≥6 months within 2 years. We used multivariate Cox proportional hazards models to examine risk factors for cLEE. RESULTS: Of 2779 participants, 309 (11%) met criteria for cLEE for an incidence of 1.28/100 PYFU (1.28–1.29/100 PYFU). In an adjusted model, cLEE was associated with Hispanic/other ethnicity (reference Caucasian: hazard ratio [HR], 1.744; 95% CI, 1.270–2.395), non–nucleoside reverse transcriptase inhibitor–based cART (reference boosted protease inhibitors: HR, 2.232; 95% CI, 1.378–3.616), being cART naïve (HR, 6.046; 95% CI, 3.686–9.915), or having cART interruptions (HR, 8.671; 95% CI, 4.651–16.164). African American race (HR, 0.669; 95% CI, 0.510–0.877) and integrase strand transfer inhibitor (INSTI)–based cART (HR, 0.222; 95% CI, 0.104–0.474) were protective. CONCLUSIONS: Our findings demonstrate that initiation and continued use of cART are protective against cLEE and support the hypothesis that HIV infection directly impacts the liver. INSTI-based regimens were protective and could be considered in persons with cLEE.
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spelling pubmed-79536612021-03-17 Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era Wood, Shannon Won, Seung Hyun Hsieh, Hsing-Chuan Lalani, Tahaniyat Kronmann, Karl Maves, Ryan C Utz, Gregory Schofield, Christina Colombo, Rhonda E Okulicz, Jason F Blaylock, Jason Agan, Brian K Ganesan, Anuradha Open Forum Infect Dis Major Articles BACKGROUND: As morbidity due to viral coinfections declines among HIV-infected persons, changes in liver-related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated with chronic liver enzyme elevation (cLEE) in HIV-monoinfected patients in the combination antiretroviral therapy (cART) era. METHODS: Participants who were hepatitis B virus and hepatitis C virus seronegative with follow-up after 1996 were included. We defined chronic liver enzyme elevation (cLEE) as alanine aminotransferase elevations ≥1.25 times the upper limit of normal on at least 2 visits, for a duration of ≥6 months within 2 years. We used multivariate Cox proportional hazards models to examine risk factors for cLEE. RESULTS: Of 2779 participants, 309 (11%) met criteria for cLEE for an incidence of 1.28/100 PYFU (1.28–1.29/100 PYFU). In an adjusted model, cLEE was associated with Hispanic/other ethnicity (reference Caucasian: hazard ratio [HR], 1.744; 95% CI, 1.270–2.395), non–nucleoside reverse transcriptase inhibitor–based cART (reference boosted protease inhibitors: HR, 2.232; 95% CI, 1.378–3.616), being cART naïve (HR, 6.046; 95% CI, 3.686–9.915), or having cART interruptions (HR, 8.671; 95% CI, 4.651–16.164). African American race (HR, 0.669; 95% CI, 0.510–0.877) and integrase strand transfer inhibitor (INSTI)–based cART (HR, 0.222; 95% CI, 0.104–0.474) were protective. CONCLUSIONS: Our findings demonstrate that initiation and continued use of cART are protective against cLEE and support the hypothesis that HIV infection directly impacts the liver. INSTI-based regimens were protective and could be considered in persons with cLEE. Oxford University Press 2021-02-24 /pmc/articles/PMC7953661/ /pubmed/33738323 http://dx.doi.org/10.1093/ofid/ofab076 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles
Wood, Shannon
Won, Seung Hyun
Hsieh, Hsing-Chuan
Lalani, Tahaniyat
Kronmann, Karl
Maves, Ryan C
Utz, Gregory
Schofield, Christina
Colombo, Rhonda E
Okulicz, Jason F
Blaylock, Jason
Agan, Brian K
Ganesan, Anuradha
Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title_full Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title_fullStr Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title_full_unstemmed Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title_short Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era
title_sort risk factors associated with chronic liver enzyme elevation in persons with hiv without hepatitis b or c coinfection in the combination antiretroviral therapy era
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953661/
https://www.ncbi.nlm.nih.gov/pubmed/33738323
http://dx.doi.org/10.1093/ofid/ofab076
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