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Clinical significance of elevated liver transaminases in HIV-infected patients

Cai, Jiaa; Osikowicz, Mariab; Sebastiani, Giadab

doi: 10.1097/QAD.0000000000002233

Elevation of liver transaminases is common in patients infected with the HIV. Although this is usually an incidental finding during regular work-up, HIV-infected patients with transaminase elevations require additional visits for laboratory studies and clinical assessments, and often undergo interruptions and changes in antiretroviral therapy (ART). Alanine aminotransferase is present primarily in the liver, thus being a surrogate marker of hepatocellular injury. Aspartate aminotransferase is present in the liver and other organs, namely cardiac and skeletal muscle, kidney and brain. Serum levels of both liver transaminases predict liver-related mortality. Moreover, serum fibrosis biomarkers based on alanine aminotransferase and aspartate aminotransferase predict all-cause mortality. In a busy clinical setting, a diagnostic approach to elevated liver transaminases could be complicated given the frequency and nonspecificity of this finding. Indeed, HIV-infected individuals present multiple risk factors for liver damage and chronic elevation of transaminases, including coinfection with hepatitis B and C viruses, alcohol abuse, hepatotoxicity due to ART, HIV itself and frequent metabolic comorbidities leading to nonalcoholic fatty liver disease. This review provides an update on epidemiology of elevated liver transaminases, summarizes the main etiologic contributors and discusses the prognostic significance and a pragmatic approach to this frequent finding in the clinical practice of HIV medicine. With the aging of the HIV-infected population following the successful implementation of ART in Western countries, liver-related conditions are now a major comorbidity in this setting. As such, clinicians should be aware of the frequency, clinical significance and diagnostic approach to elevated liver transaminases.

aDepartment of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

bDivision of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Quebec, Canada.

Correspondence to Giada Sebastiani, MD, Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Center, 1001 Décarie Blvd., Montreal, QC, Canada H4A 3J1. E-mail:

Received 18 December, 2018

Revised 1 March, 2019

Accepted 1 March, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.