Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations?: A New Definition Derived From a Large Cohort Study

Loveleen Bansi; Jo Turner; Richard Gilson; Frank Post; Brian Gazzard; Clifford Leen; Jane Anderson; Kholoud Porter; Teresa Hill; Martin Fisher; Jonathan Ainsworth; Deenan Pillay; Margaret Johnson; Alan Winston; Chloe Orkin; Philippa Easterbrook; Andrew Phillips; Caroline Sabin; UK Collaborative HIV Cohort Study

doi:10.1097/QAI.0b013e3181ab73cc

Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study

Loveleen Bansi, Jo Turner, Richard Gilson, Frank Post, Brian Gazzard, Clifford Leen, Jane Anderson, Kholoud Porter, Teresa Hill, Martin Fisher, Jonathan Ainsworth, Deenan Pillay, Margaret Johnson, Alan Winston, Chloe Orkin, Philippa Easterbrook, Andrew Phillips, Caroline Sabin, UK Collaborative HIV Cohort Study

King's College London

UCL University College London

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objectives: Recent studies have suggested that highly active antiretroviral therapy may lead to rises in alanine transaminase (ALT) among HIV-infected patients. However, the definition of an ALT flare is arbitrary and the extent to which such increases represent normal fluctuations has not been explored.

Methods: Using data from untreated, hepatitis B virus/hepatitis C virus-negative, HIV-infected patients, we derived a definition for an ALT flare by exploring a series of ALT thresholds (from 100 to 200 IU/L). The resulting definition (2 consecutive ALTs > 200 measured >2 weeks apart) was applied to all patients in the UK Collaborative HIV Cohort (CHIC) Study, and Poisson regression was used to identify factors associated with ALT flares.

Results: Five hundred and twenty six of 12,206 eligible patients (4.3%) had >=1 ALT flare, resulting in a total of 615 episodes of ALT flares. The overall rate of an ALT flare was 1.19 (95% confidence interval: 1.10 to 1.28) per 100 person-years. Higher risk of ALT flare was associated with lower CD4 counts, detectable viral loads, being under follow-up in earlier calendar years, prior clinical AIDS, receipt of nevirapine either with didanosine/stavudine or without didanosine/stavudine, receipt of ritonavir, detectable anti-hepatitis C virus, and detectable hepatitis B surface antigen.

Conclusions: Associations between known risk factors may be under/over estimated if using single values, that is, 1 ALT > 200, to define ALT flares. We recommend studies to use a more stringent measure and suggest our derived definition of an ALT flare.

Original language	English
Article number	N/A
Pages (from-to)	391-396
Number of pages	6
Journal	Journal of acquired immune deficiency syndromes (1999)
Volume	52
Issue number	3
DOIs	https://doi.org/10.1097/QAI.0b013e3181ab73cc
Publication status	Published - Nov 2009

Keywords

Adult
Alanine Transaminase
Anti-HIV Agents
Antiretroviral Therapy, Highly Active
Cohort Studies
Female
HIV Infections
Hepatitis B
Hepatitis C
Humans
Male

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/QAI.0b013e3181ab73cc

Cite this

Bansi, L., Turner, J., Gilson, R., Post, F., Gazzard, B., Leen, C., Anderson, J., Porter, K., Hill, T., Fisher, M., Ainsworth, J., Pillay, D., Johnson, M., Winston, A., Orkin, C., Easterbrook, P., Phillips, A., Sabin, C., & UK Collaborative HIV Cohort Study (2009). Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study. Journal of acquired immune deficiency syndromes (1999), 52(3), 391-396. Article N/A. https://doi.org/10.1097/QAI.0b013e3181ab73cc

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abstract = "Objectives: Recent studies have suggested that highly active antiretroviral therapy may lead to rises in alanine transaminase (ALT) among HIV-infected patients. However, the definition of an ALT flare is arbitrary and the extent to which such increases represent normal fluctuations has not been explored. Methods: Using data from untreated, hepatitis B virus/hepatitis C virus-negative, HIV-infected patients, we derived a definition for an ALT flare by exploring a series of ALT thresholds (from 100 to 200 IU/L). The resulting definition (2 consecutive ALTs > 200 measured >2 weeks apart) was applied to all patients in the UK Collaborative HIV Cohort (CHIC) Study, and Poisson regression was used to identify factors associated with ALT flares. Results: Five hundred and twenty six of 12,206 eligible patients (4.3%) had >=1 ALT flare, resulting in a total of 615 episodes of ALT flares. The overall rate of an ALT flare was 1.19 (95% confidence interval: 1.10 to 1.28) per 100 person-years. Higher risk of ALT flare was associated with lower CD4 counts, detectable viral loads, being under follow-up in earlier calendar years, prior clinical AIDS, receipt of nevirapine either with didanosine/stavudine or without didanosine/stavudine, receipt of ritonavir, detectable anti-hepatitis C virus, and detectable hepatitis B surface antigen. Conclusions: Associations between known risk factors may be under/over estimated if using single values, that is, 1 ALT > 200, to define ALT flares. We recommend studies to use a more stringent measure and suggest our derived definition of an ALT flare.",

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author = "Loveleen Bansi and Jo Turner and Richard Gilson and Frank Post and Brian Gazzard and Clifford Leen and Jane Anderson and Kholoud Porter and Teresa Hill and Martin Fisher and Jonathan Ainsworth and Deenan Pillay and Margaret Johnson and Alan Winston and Chloe Orkin and Philippa Easterbrook and Andrew Phillips and Caroline Sabin and {UK Collaborative HIV Cohort Study}",

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Bansi, L, Turner, J, Gilson, R, Post, F, Gazzard, B, Leen, C, Anderson, J, Porter, K, Hill, T, Fisher, M, Ainsworth, J, Pillay, D, Johnson, M, Winston, A, Orkin, C, Easterbrook, P, Phillips, A, Sabin, C & UK Collaborative HIV Cohort Study 2009, 'Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study', Journal of acquired immune deficiency syndromes (1999), vol. 52, no. 3, N/A, pp. 391-396. https://doi.org/10.1097/QAI.0b013e3181ab73cc

Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations? A New Definition Derived From a Large Cohort Study. / Bansi, Loveleen; Turner, Jo; Gilson, Richard et al.
In: Journal of acquired immune deficiency syndromes (1999), Vol. 52, No. 3, N/A, 11.2009, p. 391-396.

Research output: Contribution to journal › Article › peer-review

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T1 - Is 1 Alanine Transaminase >200 IU Enough to Define an Alanine Transaminase Flare in HIV-Infected Populations?

T2 - A New Definition Derived From a Large Cohort Study

AU - Bansi, Loveleen

AU - Turner, Jo

AU - Gilson, Richard

AU - Post, Frank

AU - Gazzard, Brian

AU - Leen, Clifford

AU - Anderson, Jane

AU - Porter, Kholoud

AU - Hill, Teresa

AU - Fisher, Martin

AU - Ainsworth, Jonathan

AU - Pillay, Deenan

AU - Johnson, Margaret

AU - Winston, Alan

AU - Orkin, Chloe

AU - Easterbrook, Philippa

AU - Phillips, Andrew

AU - Sabin, Caroline

AU - UK Collaborative HIV Cohort Study

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N2 - Objectives: Recent studies have suggested that highly active antiretroviral therapy may lead to rises in alanine transaminase (ALT) among HIV-infected patients. However, the definition of an ALT flare is arbitrary and the extent to which such increases represent normal fluctuations has not been explored. Methods: Using data from untreated, hepatitis B virus/hepatitis C virus-negative, HIV-infected patients, we derived a definition for an ALT flare by exploring a series of ALT thresholds (from 100 to 200 IU/L). The resulting definition (2 consecutive ALTs > 200 measured >2 weeks apart) was applied to all patients in the UK Collaborative HIV Cohort (CHIC) Study, and Poisson regression was used to identify factors associated with ALT flares. Results: Five hundred and twenty six of 12,206 eligible patients (4.3%) had >=1 ALT flare, resulting in a total of 615 episodes of ALT flares. The overall rate of an ALT flare was 1.19 (95% confidence interval: 1.10 to 1.28) per 100 person-years. Higher risk of ALT flare was associated with lower CD4 counts, detectable viral loads, being under follow-up in earlier calendar years, prior clinical AIDS, receipt of nevirapine either with didanosine/stavudine or without didanosine/stavudine, receipt of ritonavir, detectable anti-hepatitis C virus, and detectable hepatitis B surface antigen. Conclusions: Associations between known risk factors may be under/over estimated if using single values, that is, 1 ALT > 200, to define ALT flares. We recommend studies to use a more stringent measure and suggest our derived definition of an ALT flare.

AB - Objectives: Recent studies have suggested that highly active antiretroviral therapy may lead to rises in alanine transaminase (ALT) among HIV-infected patients. However, the definition of an ALT flare is arbitrary and the extent to which such increases represent normal fluctuations has not been explored. Methods: Using data from untreated, hepatitis B virus/hepatitis C virus-negative, HIV-infected patients, we derived a definition for an ALT flare by exploring a series of ALT thresholds (from 100 to 200 IU/L). The resulting definition (2 consecutive ALTs > 200 measured >2 weeks apart) was applied to all patients in the UK Collaborative HIV Cohort (CHIC) Study, and Poisson regression was used to identify factors associated with ALT flares. Results: Five hundred and twenty six of 12,206 eligible patients (4.3%) had >=1 ALT flare, resulting in a total of 615 episodes of ALT flares. The overall rate of an ALT flare was 1.19 (95% confidence interval: 1.10 to 1.28) per 100 person-years. Higher risk of ALT flare was associated with lower CD4 counts, detectable viral loads, being under follow-up in earlier calendar years, prior clinical AIDS, receipt of nevirapine either with didanosine/stavudine or without didanosine/stavudine, receipt of ritonavir, detectable anti-hepatitis C virus, and detectable hepatitis B surface antigen. Conclusions: Associations between known risk factors may be under/over estimated if using single values, that is, 1 ALT > 200, to define ALT flares. We recommend studies to use a more stringent measure and suggest our derived definition of an ALT flare.

KW - Adult

KW - Alanine Transaminase

KW - Anti-HIV Agents

KW - Antiretroviral Therapy, Highly Active

KW - Cohort Studies

KW - Female

KW - HIV Infections

KW - Hepatitis B

KW - Hepatitis C

KW - Humans

KW - Male

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DO - 10.1097/QAI.0b013e3181ab73cc

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