Table 1.
Selected Demographic and Clinical Characteristics of HIV-Infected Adults With Chronic, Unexplained Elevations in Aminotransferases While on Antiretroviral Therapy (N = 62)
| Characteristic | No. (%) or Median (Range) |
|---|---|
| Age, y | 50 (17–67) |
| Male sex | 58 (94%) |
| Race (self-identified) | |
| White | 40 (65%) |
| Black | 5 (8%) |
| Asian | 2 (3%) |
| Not selected/mixed race | 15 (24%) |
| Ethnicity (self-identified) | |
| Hispanic/Latino | 18 (29%) |
| Not Hispanic/Latino | 44 (71%) |
| Time since HIV diagnosis, y | 17.5 (2.3–27.8) |
| CD4+ nadir, cells/µL | 180 (6–599) |
| CD4+ count at enrollment, cells/µL | 548 (105–1631) |
| HIV RNA load, copies/mL | <40 (<40–726) |
| Total duration of antiretroviral therapy, y | 12.9 (1.7–22.8) |
| Antiretroviral therapy at enrollment | |
| NRTI | 60 (97%) |
| Zidovudine | 11 (18%) |
| Stavudine | 3 (5%) |
| Didanosine | 0 (0%) |
| Lamivudine or emtricitabine | 57 (92%) |
| Tenofovir | 44 (71%) |
| Abacavir | 14 (23%) |
| NNRTI | 33 (53%) |
| Protease inhibitor | 29 (47%) |
| Integrase inhibitor | 14 (23%) |
| Efuvirtide | 1 (2%) |
| Maraviroc | 1 (2%) |
| Previous antiretroviral exposure per patient | |
| No. of agents by class | |
| NRTI | 2 (0–7) |
| NNRTI | 1 (0–2) |
| Protease inhibitor | 1 (0–5) |
| Lipodystrophy, clinical history | 26 (42%) |
| Duration of AST and/or ALT elevation at biopsy, y | 3.7 (1.1–11.4) |
| AST, U/L (normal range, 9–34 U/L) | 46 (19–411) |
| ALT, U/L (normal range 6–41 U/L) | 72 (27–1244) |
| ALT ≤82 U/L (≤2× ULN) | 38 (61%) |
| ALT > 82–123 U/L (2–3× ULN) | 12 (19%) |
| ALT >123 U/L (3× ULN) | 12 (19%) |
| GGT, U/L (normal range, 11–52 U/L) | 97 (20–977) |
| Platelet count, × 1000/µL (normal range, 150–400 × 1000/µL) | 208 (79–380) |
| BMI, kg/m2 | 27.6 (15.3–47.1) |
| Overweight (25–29.9) | 29 (48%) |
| Obese (≥30) | 19 (31%) |
| Waist circumference, cm (n = 53) | 96 (63–147) |
| Waist-to-hip circumference ratio | 1.0 (0.8–1.1) |
| Known diabetes mellitus | 2 (3%) |
| 2-hour glucose (oral 75-g glucose tolerance test) (n = 57)a | |
| Normal (<140 mg/dL) | 39 (68%) |
| Impaired glucose tolerance (140–199 mg/dL) | 14 (25%) |
| New diagnosis diabetes mellitus (≥200 mg/dL) | 4 (7%) |
| HOMA-IR (n = 60)a | 4.5 (0.2–154.3) |
| HOMA-IR > 2.6 | 49 (82%) |
| HOMA-IR > 3.8 | 35 (58%) |
| Use of antilipid therapy, any | 29 (47%) |
| Statin use | 22 (35%) |
| Total cholesterol, mmol/L | 191 (95–422) |
| HDL cholesterol, mmol/L | 39 (16–114) |
| Triglycerides, mmol/L | 193 (51–553) |
| Abdominal CT imaging (n = 60) | |
| Decreased liver density, consistent with steatosis (clinical read) | 17 (28%) |
| Hepatomegaly | 6 (8%) |
| Splenomegaly | 8 (13%) |
| Abdominal CT image analysis (n = 60) | |
| Adipose tissue volume at L4/5, cm3 | |
| Subcutaneous | 142 (8–592) |
| Visceral | 171 (16–451) |
| Subcutaneous/visceral ratio | 1.1 (0.1–16.3) |
| Liver and spleen attenuation, HU | |
| Liver attenuation | 54 (19–74) |
| Spleen attenuation | 52 (12–126) |
| Liver/spleen attenuation ratio | 1.1 (0.3–2.0) |
| Liver/spleen attenuation ratio <1.0 | 19 (32%) |
| Liver volume, cm3 | 2211 (1447–4930) |
| Spleen volume, cm3 | 371 (119–1011) |
Median and range presented unless noted otherwise.
Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CT, computed tomography; GGT, gamma-glutamyl transpeptidase; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; HOMA-IR, homeostatic model assessment of insulin resistance; HU, Hounsfield units; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleos(t)ide reverse transcriptase inhibitor; ULN, upper limit of normal.
a Two participants with known diabetes mellitus did not undergo oral glucose tolerance testing and were not included in the HOMA-IR calculations.