Long-term trends of alanine aminotransferase levels (ALT) among persons living with HIV/hepatitis B virus with and without hepatitis delta coinfection. Frontiers in Medicine
Begré et al. explored long-term trends of ALT levels in individuals with HIV/HBV coinfection in a multi-cohort collaboration between the Swiss HIV Cohort Study (SHCS), the EuroSIDA study, and the French HIV/HBV cohort.
All individuals with confirmed chronic HBV infection (two HBsAg positive values, more than six months apart) who started tenofovir containing antiretroviral therapy (ART) were included. Risk factors for persistent ALT elevation (>1.25 times upper limit of normal) were assessed, including the role of hepatitis D virus (HDV) coinfection, using multivariable logistic regression. In addition, differences in mean ALT levels over time were evaluated using multivariable mixed effect models.
The study included 518 individuals (median age 40 years, 19% female, 9% with liver cirrhosis); 61 persons (12%) had HDV coinfection, and the median follow-up time was 9.1 years (IQR 5.6-13.3). 121 individuals (23%) had at least mild ALT elevation 5 years after starting ART treatment. HDV coinfection was associated with persistent ALT elevation after 5 years (aOR 2.8, 95% CI 1.4-5.8), as was obesity (aOR 3.2, 95% 1.2-8.0) and higher ALT at baseline (aOR 2.3, 95% CI 1.4-3.8). Individuals with HDV coinfection had persistently higher ALT levels at baseline (+17 IU/L, 95% CI 5-29), after 2 years (+20 IU/L, 95% CI 10-29) and after 5 years (+15 IU/L, 95% CI 0-31) compared to individuals with HDV.
Taken together, the present study shows that persistent ALT elevation after tenofovir start is common in individuals with HIV and HBV, and that HDV infection acts as a strong risk factor for persistent liver inflammation. Monitoring of ALT remains important in this population, especially in individuals with additional risk factors such as obesity or older age.