Low liver dysfunction observed after cART among children with HIV

Asian children with HIV showed low incidence and prevalence rates for liver dysfunction before and after cART, according to research presented at the International AIDS Conference in Melbourne, Australia.

Researchers analyzed data from children with HIV in the TREAT Asia Pediatric HIV observational database. Levels of aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) index were calculated and assessed to determine any incidence or prevalence of liver dysfunction before and after combination ART (cART).

The study included 1,930 children (49% male), aged 2 to 18 years, and 98% were perinatally infected with HIV. Among them, 9% had APRI scores greater than 1.5, and 2.7 % had FIB-4 index scores greater than 1.3. Sixty-two percent of patients underwent nevirapine-based cART, 32% had efavirenz-based therapy and 6% underwent therapy with protease inhibitors.

Incidence analysis included 1,143 patients with normal baseline alanine aminotransferase (ALT) levels. After cART, ALT incidence five times the upper limit of normal (ULN) occurred in 0.4 per 1,000 person-months (95% CI, 0.27-0.61). APRI incidence scores that exceeded 1.5 were 0.77 per 1,000 person-months, and the rate for patients with FIB-4 index scores greater than 1.3 was 0.63 per 1,000 person-months.

In multivariate analysis, severe anemia before cART (HR=2.96; 95% CI, 1.22-7.18) was a predictor of ALT at least three times the baseline level or ULN. Among patients aged 5 to 9 years, a protective factor was observed (HR=0.48; 95% CI, 0.27-0.84).

“We demonstrated a low prevalence and incidence of liver dysfunction before and after cART initiation,” the researchers wrote. “Continuous monitoring during cART is required. Those with persistent abnormalities might be targeted for further evaluation of liver pathology.”

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Aurpibul L. #MOPE070. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.

Disclosure: Relevant financial disclosures were not provided by researchers.