NYMC Faculty Publications

Association of Abnormal Liver Function Parameters With HIV Serostatus and CD4 Count in Antiretroviral-Naive Rwandan Women

Author Type(s)

Faculty

DOI

10.1089/AID.2014.0170

Journal Title

AIDS Research and Human Retroviruses

First Page

723

Last Page

730

Document Type

Article

Publication Date

7-1-2015

Department

Biostatistics

Second Department

Public Health

Keywords

Adult, Alanine Transaminase, Aspartate Aminotransferases, CD4 Lymphocyte Count, Female, HIV Infections, Humans, Liver Diseases, Liver Function Tests, Middle Aged, Prevalence, Prospective Studies, Rwanda, Serum Albumin

Disciplines

Medicine and Health Sciences

Abstract

We determined the associations of HIV infection/CD4 count with markers of hepatocellular damage [elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and liver synthetic function (decreased albumin) in HIV-infected (HIV(+)) antiretroviral therapy (ART)-naive and uninfected (HIV(-)) Rwandan women. In 2005, 710 HIV(+) ART-naive and 226 HIV(-) women enrolled in the Rwanda Women's Interassociation Study and Assessment. Liver enzymes were measured with abnormality defined as either AST or ALT ≥1.25 times the upper limit of normal. Low serum albumin level was defined as < 3.5 g/dl. Multivariable logistic regression analysis identified independent predictors of elevated AST/ALT and low serum albumin. HIV(-) women had the lowest prevalence (6.6%) of abnormal AST/ALT, with the highest prevalence (16.4%) in HIV(+) women with CD4 < 200 cells/μl (p=0.01). The odds of having serum albumin < 3.5 g/dl was 5.7-fold higher in HIV(+) than HIV(-) women (OR=5.68, 95% CI: 3.32-9.71). The risk of low albumin decreased from low to high CD4 count, with OR=2.62, 95% CI: 1.66, 4.14 and OR=1.57, 95% CI: 1.01, 2.43 in HIV(+) women with a CD4 count < 200 and 200-350 cells/μl, respectively vs. HIV(+) with CD4 >350 (p< 0.001 and p< 0.05 for all comparisons). Our findings suggest that HIV-associated liver damage may occur in ART-naive patients. Although liver abnormality prevalences in this cohort of HIV-infected Rwandan women are less than reported in developed countries, caution is needed for risk assessment measures to monitor and screen HIV-infected patients pre- and post-ART initiation in African clinical settings to curtail potential risks associated with HIV infection.

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