| Title | Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study. | | Author(s) | Bansi L, Turner J, Gilson R, Post F, Gazzard B, Leen C, Anderson J, Porter K, Hill T, Fisher M, Ainsworth J, Pillay D, Johnson M, Winston A, Orkin C, Easterbrook P, Phillips A, Sabin C, on behalf of the UK Collaborative HIV Cohort (CHIC) Study | | Institution | From the *Research Department of Infection and Population Health, University College London Medical School, London, UK; daggerDepartment of HIV/GU Medicine, King's College London, London, UK; double daggerDepartment of HIV/GUM, Chelsea and Westminster NHS Trust, London, UK; section signRegional Infectious Diseases Unit, The Lothian University Hospitals NHS Trust, Edinburgh, UK; parallelCentre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Trust, London, UK; paragraph signMedical Research Council, Clinical Trials Unit, London, UK; #Department of HIV/Genitourinary Medicine, Brighton and Sussex University Hospitals, NHS Foundation Trust, Brighton, UK; **HIV Unit, North Middlesex University Hospital NHS Trust, London, UK; daggerdaggerDepartment of Virology, UCL, London, United Kingdom; double daggerdouble daggerDepartment of HIV Medicine, Royal Free NHS Trust, London, UK; section sign section signSection of Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK; and parallel parallelDepartment of Infection and Immunity, Barts and The London NHS Trust, London, UK. | | Source | J Acquir Immune Defic Syndr 2009 Jun 23. | | Abstract | OBJECTIVES:: Recent studies have suggested that highly active antiretroviral therapy may lead to rises in alanine transaminase (ALT) among HIV-infected patients. However, the definition of an ALT flare is arbitrary and the extent to which such increases represent normal fluctuations has not been explored.
METHODS:: Using data from untreated, hepatitis B virus/hepatitis C virus-negative, HIV-infected patients, we derived a definition for an ALT flare by exploring a series of ALT thresholds (from 100 to 200 IU/L). The resulting definition (2 consecutive ALTs > 200 measured >2 weeks apart) was applied to all patients in the UK Collaborative HIV Cohort (CHIC) Study, and Poisson regression was used to identify factors associated with ALT flares.
RESULTS:: Five hundred and twenty six of 12,206 eligible patients (4.3%) had >/=1 ALT flare, resulting in a total of 615 episodes of ALT flares. The overall rate of an ALT flare was 1.19 (95% confidence interval: 1.10 to 1.28) per 100 person-years. Higher risk of ALT flare was associated with lower CD4 counts, detectable viral loads, being under follow-up in earlier calendar years, prior clinical AIDS, receipt of nevirapine either with didanosine/stavudine or without didanosine/stavudine, receipt of ritonavir, detectable anti-hepatitis C virus, and detectable hepatitis B surface antigen.
CONCLUSIONS:: Associations between known risk factors may be under/over estimated if using single values, that is, 1 ALT > 200, to define ALT flares. We recommend studies to use a more stringent measure and suggest our derived definition of an ALT flare. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19553826 |
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