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Biopsy detects significant liver disease in HIV patients
Liver biopsy appeared to be effective in identifying clinically significant liver disease, including nonalcoholic steatohepatitis and fibrosis, in HIV-infected adults on ART who have chronic transaminase elevations, according to recent findings.
“The impact of chronic transaminase elevations, and any related liver damage, on morbidity and mortality has not been well defined,” researchers wrote in Clinical Infectious Diseases. “As a consequence, at present there are no established guidelines as to when ART should be changed or discontinued in the setting of mild-to-moderate transaminase elevations.”
Caryn G. Morse, MD, of the NIH Clinical Center, and colleagues evaluated 62 HIV-monoinfected adult patients with elevated transaminases while receiving ART. Eligible participants were being treated with combination ART for more than 1 year and had elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) above the high range of normal (AST > 34 U/L or ALT > 41 U/L) on more than three occasions over at least 6 months. The patients had no evidence of active viral hepatitis, hereditary or autoimmune liver disease or hemochromatosis, no ongoing alcohol abuse, and no contraindications to liver biopsy.
Each patient underwent a detailed metabolic assessment and liver biopsy.
The researchers detected clinically significant liver pathology in 65% of the patients, including 55% with nonalcoholic steatohepatitis (NASH) and 11 (18%) with bridging fibrosis, 10 of whom also were diagnosed with NASH. Thirty-five percent of patients had nonspecific abnormalities alone, and these included mild steatosis, mild-to-moderate inflammation and signs of drug adaptation. Insulin resistance, obesity and the presence of one of two minor alleles in the PNPLA3 gene were associated with an elevated risk for NASH and fibrosis. No association was seen between NASH and/or fibrosis and the duration of HIV infection or ART, specific ART regimens, history of opportunistic infection, immune status or duration of high transaminase levels.
The researchers said that ongoing follow-up will focus on finding noninvasive methods of detecting potential liver disease progression.
“Long-term follow-up of this cohort will provide important information about the clinical consequences of these findings,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.