597. The Incidence and Risk Factors Associated with Chronic Liver Enzyme Elevation (cLEE) in HIV-Monoinfected Persons
Session: Poster Abstract Session: HIV: Kidney, Bone + Liver Effects
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Wood_IDSA poster_Final.pdf (322.5 kB)
  • Background: Chronic liver-associated enzyme elevations (cLEE) are common in persons with HIV; however, the significance in patients without hepatitis B or C co-infection remains unclear. The aims of this study were to evaluate the incidence and risk factors associated with cLEE in HIV-monoinfected subjects enrolled in the US Military HIV Natural History Study (NHS).

    Methods: We included NHS subjects who were HBV and HCV seronegative with follow-up after 1996. cLEE was defined as alanine amino transferase (ALT) levels ≥ 1.25x the upper limit of normal recorded at ≥ 2 visits spanning a period of 6 months within 2 years. Baseline characteristics between patients with and without cLEE were compared. Percentages are presented for categorical variables with medians and interquartile ranges presented for continuous variables. Multivariate Cox proportional hazards models were used to examine risk factors for cLEE.

    Results: Of 3,163 included patients, 367 (11.7%) met criteria for cLEE. The incidence of cLEE was 1.4/100 person years of follow-up (1.2-1.5) with a period prevalence of 35%. Significant differences in baseline characteristics between groups are tabulated below. The median time from HIV diagnosis to cLEE was 5 years (3-8) with the majority of ALT elevations categorized as grade 1 (40%). BMI was significantly associated with cLEE only in the unadjusted model. In an adjusted model, male gender (HR 1.7 [1.0-2.8]) and Hispanic/Other race (compared with Caucasians: HR 1.8 [1.3-2.5]) were associated with cLEE while African American race was protective (compared with Caucasians: HR 0.75 [0.58 – 0.98]). Use of antiretroviral therapy [ART] (HR 1.9 [1.2-3.0]) and non-ART antiretrovirals (HR 2.0 [1.1-3.4]) were also associated with cLEE.

    Conclusion: cLEE is common in the NHS, although the incidence rate is lower than that reported in other cohorts. ART use was associated with cLEE emphasizing the need for surveillance of liver enzymes in patients on ART. The association between race and cLEE needs further evaluation.

    Variable

    Total

    no cLEE

    cLEE

    P-Value

    Year of HIV dx

    2000

    (1992,2008)

    2001

    (1993,2008)

    1994

    (1988,2002)

    <.0001

    Years on ART

    3.7

    (1.8,6.3)

    1.7

    (0.9,2.7)

    4.1

    (2.0,6.5)

    <.0001

    Nadir CD4 count

    312

    (216,420)

    320

    (225,431)

    257

    (134,362)

    <.0001

    BMI

    25

    (23,28)

    25

    (23.0,27.45)

    26

    (24,29)

    0.0021

    Shannon Wood, MD, MPH1, Morgan Byrne, MPH2, Robert Deiss, MD3, Jason Okulicz, MD4, Thomas O'Bryan, MD5, Christina Schofield, MD FACP, FIDSA6, Tomas Ferguson, MD, FIDSA7, Timothy J. Whitman, DO8, Brian Agan, MD9 and Anuradha Ganesan, MD, MPH5, (1)Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, MD, (3)Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX, (5)Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, (6)Madigan Army Medical Center, Tacoma, WA, (7)Department of Medicine, Tripler Army Medical Center, Honolulu, HI, (8)Walter Reed National Military Medical Center, Bethesda, MD, (9)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD

    Disclosures:

    S. Wood, None

    M. Byrne, None

    R. Deiss, None

    J. Okulicz, None

    T. O'Bryan, None

    C. Schofield, None

    T. Ferguson, None

    T. J. Whitman, None

    B. Agan, None

    A. Ganesan, None

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