Antiretroviral drugs and risk of chronic alanine aminotransferase elevation in HIV-monoinfected persons: The D:A:D Study. Open Forum Infectious Diseases
Kovari et al. on behalf of the D:A:D Study Group aimed to identify risk factors associated with chronic liver enzyme elevation (cLEE) among HIV-positive individuals without viral hepatitis and to evaluate the outcome of liver enzyme elevation with regard to liver-related and all-cause mortality. Among 21’485 participants observed for 105 413 person-years (PY), 6’368 (29.6%) participants experienced episodes of cLEE, resulting in an incidence of 6.04 per 100 person years of follow-up (PYFU). There was an association of cLEE with short- and long-term exposure to tenofovir disoproxil fumarate, didanosine and stavudine, but only with short-term exposure to emtricitabine, nevirapine, efavirenz, and atazanavir. Exposure to lamivudine was inversely correlated with cLEE. All-cause mortality was slightly higher in those who ever had an episode of cLEE compared with participants without cLEE (0.66/100 PYFU versus 0.60/100 PYFU), but this was not significant.
In conclusion, the novel tenofovir-cLEE signal should be further investigated to understand the pathophysiological mechanisms and its clinical implications.