Serial Testing of Liver Chemistries and Hbv Dna during Antiretroviral Treatment in Patients with Hiv/hbv Co-infection

We studied the association between hepatitis B virus (HBV) replicative markers and aminotransferases values during a 18 months interval after late initiation of highly active antiretroviral therapy (HAART) in a sample of 126 teenagers with more than ten years old HBV/HIV co-infection. Our objective was to differentiate between drug induced and disease induced alterations of liver laboratory tests. We evaluated the patients according to the degree of hepatic injury expressed by aminotransferases levels. We chosen as reference values the upper normal limit (UNL) of aminotransferases determinate in our laboratory on more than 300 samples from healthy adolescents: 24 for boys, respectively, 18 mIU/L for girls for ALT and, 30 for boys, respectively, 26 mIU/L for girls for AST. The average ALT value in HIV monoinfected subjects was 33-35 and in HIV HBV coinfected patients was 48–50 IU/mL. The data for AST have the same trend. Significant higher values were registered for ALT than for AST, especially in coinfected boys. The percent of patients with aminotransferase over 1,5 times UNL in the coinfected patients was 37.1% for ALT and 29.8% for AST. Aminotransferases values up to 2 times UNL predominated in the naive patients, over this value we registered a higher percentage of treated patients. Increases in frequency of aminotransferases higher values were registered in the added PI therapy groups. Patients with mild aminotransferases increases have had in a high percent (over 45%) HBsAg present. The presence of HBeAg is not accompanied by higher ALT values. In patients with occult hepatitis, unexpectedly, we found a higher percentage of aminotransferases values over 3 times UNL. Also in these patients prevailed elevated AST values and sometimes the inverse ALT/AST ratio. ALT is the best marker of liver inflammatory activity available, but is of limited utility in predicting degree of inflammation and of no use in estimating severity of fibrosis in HIV HBV co-infected adolescents.