Hepatitis B or C virus coinfection in and risks for transaminitis in human immunodeficiency virus - infected Thais on combined antiretroviral therapy

Background: The impact of hepatitis B or C virus (HBV or HCV) coinfection on the progression of liver diseases in patients infected with human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) has not been fully studied in resource-limited settings. Objectives: To examine the seroprevalence of HBV or HCV coinfection and its effect on hepatic function in HIV-infected Thai patients receiving HAART. Methods: A single-center cross-sectional study was conducted from October 2011 to January 2013 in Thai patients infected with HIV (n = 211). Combination ART was received by 94.3% of the patients (median duration, 32.1 (range, 0-95.3) months). The patients were screened for HBV and HCV infection and examined for transaminitis, defined as levels of aspartate aminotransferases (AST) and/or alanine aminotransferase (ALT) increased above the upper normal limits, and ARV-associated hepatotoxicity. Regression analyses were performed to determine risks for transaminitis in the studied group. Results: Prevalence of HBV or HCV coinfection in the HIV-infected patients was 11.4% and 7.6%, respectively and the rate of transaminitis was 26.5%, with only one patient developing severe grade 3 hepatotoxicity. Univariate and multivariate analyses indicated that predictive risk factors for transaminitis in this study group were seropositivity for HCV (OR 12.3, 95% CI 3.0-50.1, P < 0.001), but not for HBV, together with age difference, sex, and CD4(+) cell count. Conclusions: Coinfection with HCV is a potentially more important risk for transaminitis than coinfection with HBV, leading to chronic liver diseases in HIV-infected Thai patients with ongoing HAART.