ALT Levels Poorly Predict Liver Disease in HIV-HCV Coinfected Patients

By Liz Highleyman

Levels of alanine aminotransferase (ALT) are often used to estimate liver disease severity. However, ALT levels reflect liver inflammation, not fibrosis. Past studies have shown that some individuals with persistently normal ALT nevertheless have significant liver fibrosis.

In a study presented at the 8th International Congress on Drug Therapy in HIV Infection last month in Glasgow, Spanish researchers evaluated the usefulness of ALT levels in making decisions about disease management in HIV-HCV coinfected patients.

The investigators analyzed ALT values in the last year of follow-up in 2 groups of naive patients:

Those with no identified liver disease (exclusion of coinfection with HCV or HBV, no alcohol consumption)

Patients treated for HCV who achieved sustained virological response (SVR).

In order to establish the relationship between ALT levels and extent of liver damage, all biopsies performed in HIV-HCV coinfected patients were reviewed.

Results

Among 1603 patients attending the investigators' HIV clinic, 89 of 363 naive patients (25%) fulfilled all criteria for inclusion.

Normal ALT values (</= 40 U/L) were found in 74 patients (83%), while 15 (17%) had ALT > 40 U/L.

Similarly, of 67 patients who achieved sustained virological response after HCV therapy, 86% and 14%, respectively, had normal and elevated ALT values.

Among 282 patients who had liver biopsies, 34 had ALT </= 40 U/L and 234 had ALT > 40 U/L.

Severe fibrosis (Grades 3-4) was found in 41% of patients with normal ALT levels, including 20% who had cirrhosis.

Similar results were observed among patients with elevated ALT levels (35% with Grade 3-4 fibrosis and 15% with cirrhosis).

Conclusion

"ALT levels are not useful in the management of chronic hepatitis C in HIV infected patients," the researchers concluded, given that "up to 17% of patients with no liver disease have abnormal levels, and up to 41% of patients with normal levels have severe liver damage."

12/08/06

Reference
B Hernandez, F Dronda, A Moreno, and others. Limited value of alanine aminotransferase levels in the management of chronic hepatitis C in HIV-infected patients. 8th Congress on Drug Therapy in HIV Infection (HIV8). Glasgow. November 12-16, 2006. Abstract P317.