Objectives: Progressive liver injury is a concern in HIV-infected children exposed to long-term antiretroviral drugs and to the cytopathic effect of HIV. Yet liver biopsy is usually considered too invasive to be repeated in these patients. The aims of this study are to evaluate the feasibility of noninvasive hepatic investigations in HIV-1-infected children, assess the prevalence of signs of liver affection, and analyse the influence of the HIV disease severity and the exposure to antiretroviral therapy.
Materials and Methods: A cross-sectional study conducted in 26 HIV-1 vertically infected children ages 8 to 18 years old. Liver function was assessed with standard serum biochemical markers, FibroTest, ActiTest, SteatoTest, Forns index, aspartate aminotransferase to platelet ratio index, ultrasound, and Fibroscan.
Results: Nineteen (>60%) children had signs of liver affection on at least 1 of the test results: 13 (50%) had elevated liver enzymes, 15 (63%), 8 (33%), 5 (21%), and 5 (21%) had abnormal FibroTest, ActiTest, Forns index, and aspartate aminotransferase to platelet ratio index results, respectively. Four children (17%) had mild liver steatosis on ultrasound. Fibroscan measures were significantly higher in patients than in age-matched healthy children. Patients with elevated Fibroscan measures also had significantly higher FibroTest results. Age, HIV stage N in the Centers for Disease Control and Prevention classification and exposure duration to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor drugs were the main risk factors for hepatotoxicity.
Conclusions: More than half of our population of HIV-infected children had biological and/or radiological signs of liver affection. Regular follow-up of liver function is necessary in these patients, which is now possible with noninvasive procedures.
*Service de Physiologie et Explorations Fonctionnelles Pédiatriques, Pôle Enfants Adolescents, CHU de Nice et Université de Nice Sophia Antipolis, UFR de Médecine, France
†Service d'Hémato-Oncologie Pédiatrique, Pôle Enfants Adolescents, CHU de Nice
‡Service de Pédiatrie, Enfants Adolescents, CHU de Nice, France
§Service d'Hépato-Gastroentérologie et Nutrition, Clinique des Maladies du Foie, CHU de Nice, France
||Service d'Hépato-Gastroentérologie et Nutrition Pédiatrique, Pôle Enfants Adolescents, CHU de Nice, France
¶Laboratoire d'Immunologie, CHU de Nice, France
#Service d'Hémato-Oncologie Pédiatrique, Pôle Enfants Adolescents, CHU de Nice, France
**Service de Médecine Interne, CHU de Nice et Université de Nice Sophia Antipolis, UFR de Médecine, France
††Service de Pédiatrie, Enfants Adolescents, CHU de Nice et Université de Nice Sophia Antipolis, UFR de Médecine, France
‡‡Service d'Hépato-Gastroentérologie et Nutrition, Clinique des Maladies du Foie, CHU de Nice et Université de Nice Sophia Antipolis, UFR de Médecine, Nice, France
Received 7 September, 2008
Accepted 9 February, 2009
Address correspondence and reprint requests to Amandine Rubio, Hôpital de l'Archet, 151 route de Saint Antoine de Ginestière, 06202 Nice Cedex 3, France (e-mail: firstname.lastname@example.org).
F.T., A.T. and S.T. were supported by a grant from Association Indigo (Pr Antoine Thyss, Mme Mireille Goy-Kreitmann), Hôpital Lenval pour Enfants, Nice, France.
The authors report no conflicts of interest.