Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific

TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific

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Liver disease is a growing burden among people living with HIV (PLHIV) in resource-limited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82–8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00–5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75–8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23–3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.

Original languageEnglish
Pages (from-to)5451-5464
Number of pages14
JournalJournal of Medical Virology
Issue number11
Publication statusPublished - 2022 Nov

Bibliographical note

Funding Information:
The study team would like to acknowledge all TAHOD study members, steering committee, and patients for their support. This study was supported by the TREAT Asia HIV Observational Database, which is funded by International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, University of New South Wales Sydney. Dr. Oon Tek Ng was supported by the Singapore Ministry of Health's National Medical Research Council (NMRC) Clinician Scientist Award (MOH‐000276).

Publisher Copyright:
© 2022 Wiley Periodicals LLC.

All Science Journal Classification (ASJC) codes

  • Virology
  • Infectious Diseases


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