Liver enzymes elevation and immune reconstitution among treatment-naive HIV-infected patients instituting antiretroviral therapy

Objectives: Because liver enzymes elevation (LEE) complicates antiretroviral (ARV) therapy, and because the strongest risk factor for ARV-related LEE is HBV/HCV coinfection, it is speculated that ARV-related LEE may be a form ot immune reconstitution disease. This study summarizes the relation between immune reconstitution, ARV-induced LEE, and HBV/HCV coinfection. Methods: Medical records of ARV-naive HIV-infected patients initiating ARV were reviewed for hepatitis coinfection, LEE (grade >= 2 AST/ALT) and changes in CD4 T-cell counts over time in an urban HIV clinic. Risk factors for LEE were statistically evaluated, and changes in CD4 T-cell counts were estimated by a mixed-effects linear model. Results: Predictors of LEE included HBV/ HCV coinfection (OR = 6.44) and stavudine use (OR = 2.33). Nelfinavir use was protective (OR = 0.45). The mean rate of change in CD4 T-cell counts was higher in HBV/HCV coinfected subjects who developed LEE (99 cells/mu L per month) compared with non-coinfected subjects who did not develop LEE (59 cells/mu L per month, P = 0.03), non-coinfected subjects who developed LEE (36 cells/mu L per month, P =0.01), and coinfected subjects who did not develop LEE, 38% higher (62 cells/mu L per month; P =0.11) Conclusions: A more robust immune restoration was observed among HBV/HCV coinfected subjects who developed liver enzyme elevation after antiretroviral initiation compared with other groups. This finding suggests that ARV-related liver enzyme elevation may be related in part to immune reconstitution, as measured by changes in CD4 T-cell counts.