Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study

José Antonio Mata-Marín,José Luis Fuentes-Allen,Alfredo Alfaro-Mejía,Bernardo Horacio Grados-Chavarría,Carla Ileana Arroyo-Anduiza,Jesús Gaytán-Martínez

doi:10.1186/1743-422x-6-181

Abstract

Abnormalities in liver function tests could be produced exclusively by direct inflammation in hepatocytes, caused by the human immunodeficiency virus (HIV). Mechanisms by which HIV causes hepatic damage are still unknown. Our aim was to determine the correlation between HIV viral load, and serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as markers of hepatic damage in HIV naive infected patients.We performed a concordance cross-sectional study. Patients with antiviral treatment experience, hepatotoxic drugs use or co-infection were excluded. We used a Pearson's correlation coefficient to calculate the correlation between aminotransferases serum levels with HIV viral load. We enrolled 59 patients, 50 men and 9 women seen from 2006 to 2008. The mean (± SD) age of our subjects was 34.24 ± 9.5, AST 37.73 ± 29.94 IU/mL, ALT 43.34 ± 42.41 IU/mL, HIV viral load 199,243 ± 292,905 copies/mL, and CD4+ cells count 361 ± 289 cells/mm3. There was a moderately strong, positive correlation between AST serum levels and HIV viral load (r = 0.439, P < 0.001); and a weak correlation between ALT serum levels and HIV viral load (r = 0.276, P = 0.034); after adjusting the confounders in lineal regression model the correlation remained significant. Our results suggest that there is an association between HIV viral load and aminotransferases as markers of hepatic damage; we should improved recognition, diagnosis and potential therapy of hepatic damage in HIV infected patients.

Highlights

HIV-AIDS is one of the main causes of mortality over the world; during the last decade the amount of human immunodeficiency virus (HIV) infected patients has increased dramatically worldwide [1,2,3].In HIV infected patients, the increase in hepatic enzymes could be secondary to multiple factors such as alcoholism, lipid lowering drugs, co-infection with hepatitis viruses, or hereditary diseases; in addition, it has been proposed that HIV causes a direct damage over hepatic cells [4,5,6,7,8,9]
Many factors are associated with hepatic damage: antiretroviral treatment, co-infections with hepatitis B or C virus, opportunistic infections as citomegalovirus, mycobacterium, leishmaniasis, or tumors, cholangitis associated to parasites and toxicity related with non antiretroviral drugs[10]
The purpose of the study was to determine the correlation between HIV viral load, with serum levels of AST and ALT as markers of hepatic damage in HIV naïve infected patients

Summary

Introduction

HIV-AIDS is one of the main causes of mortality over the world; during the last decade the amount of human immunodeficiency virus (HIV) infected patients has increased dramatically worldwide [1,2,3]. In HIV infected patients, the increase in hepatic enzymes could be secondary to multiple factors such as alcoholism, lipid lowering drugs, co-infection with hepatitis viruses, or hereditary diseases; in addition, it has been proposed that HIV causes a direct damage over hepatic cells [4,5,6,7,8,9]. Mechanisms by which HIV causes hepatic damage are still unknown, but the most important mechanisms could be apoptosis (induced by caspases 2, 7 and 8) and mitochondrial dysfunction with decreasing in mitochondrial DNA in several tissues; another injury mechanism is permeability alteration in mitochondrial membrane by HIV proteins which stimulate an inflammatory response [9,10,11,12,13,14,15,16].

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