Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia-Pacific

Dhanushi Rupasinghe, Jun Yong Choi, Evy Yunihastuti, Sasisopin Kiertiburanakul, Jeremy Ross, Penh Sun Ly, Romanee Chaiwarith, Cuong Duy Do, Yu Jiun Chan, Nagalingeswaran Kumarasamy, Anchalee Avihingsanon, Adeeba Kamarulzaman, Suwimon Khusuwan, Fujie Zhang, Man Po Lee, Kinh Van Nguyen, Tuti Parwati Merati, Sashikala Sangle, Ng Oon Tek, Junko TanumaRossana Ditangco, Benedict Lim Heng Sim, Sanjay Pujari, Awachana Jiamsakul, on behalf of the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

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Liver disease is a growing burden among people living with HIV (PLHIV) in resource-limited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82–8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00–5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75–8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23–3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.

Original languageEnglish
Pages (from-to)5451-5464
Number of pages14
JournalJournal of Medical Virology
Issue number11
Publication statusPublished - Nov 2022
Externally publishedYes


  • ALT elevations
  • Asia-Pacific
  • cirrhosis
  • HIV

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