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Initial HAART Therapy Tends to Gradually Lower Elevated Liver Enzymes: Presented at AIDS 2010 By Ed Susman VIENNA -- July 26, 2010 -- Elevated liver enzymes appear to diminish after a person diagnosed with HIV undergoes treatment with highly active antiretroviral therapy (HAART), researchers reported here at the 18th International AIDS Conference 2010. In a retrospective study, about 40% of treatment-naïve patients with HIV were found to have elevated liver enzyme tests at baseline, but with 30 months of treatment on a combination drug regimen anchored by non-nucleoside reverse transcriptase inhibitors the percentage of individuals with elevated enzymes fell to about 12%, according to Ponsiano Ocama, MD, Makerere University, Kampala, Uganda. Dr. Ocama, at his poster presentation on July 19, noted that the decline in elevated enzyme tests was attenuated in men after 24 months of therapy, but continued to decline in women. He suggested that the treatment effect might have waned in men because of alcohol consumption. "We are the highest per capita consumers of beer in Africa," Dr. Ocama said. "And men in Uganda tend to drink more beer than women." In men, the fall in elevated enzymes declined to about 22% after 24 months and rose slightly to 24% at 30 months. Among women the fall was sharper and continued to be steeper in decline than men at every 6-month time point. At 30 months about 6% of women had elevated enzyme levels, Dr. Ocama said. The difference between men and women in reduction of enzyme levels achieved statistical significance (P < .0001). Dr. Ocama said baseline alcohol levels were not collected among the 546 patients whose charts were scrutinised for the study. At baseline, 217 of these patients had elevated enzyme levels, but just 1% had grade 3/4 aspartate aminotransferase elevations. Two of those 8 patients were diagnosed with jaundice. Those patients had complete data on antiretroviral therapy, socio-demographic information, and baseline liver enzyme data. The median age of the patients in the study was 38 years and 69% of the group were women. The median CD4-positive cells at the initiation of therapy was 98 cells/mm3. All the patients were initiated on therapy with a lamivudine-containing regimen, and either stavudine or zidovudine. About 74% of the patients were on the nevirapine and the rest were on efavirenz. After treatment, 12% of patients had elevated enzymes, but only 8 of those patients had clinically significant increases after treatment with antiretrovirals. Those grade 3/4 cases resolved with the withdrawal of antiretrovirals. [Presentation title: Progressive Normalization of Liver Enzyme Elevation During the First 30 Months of ART in an HIV-Positive Patient Cohort in Uganda. Abstract MOPE0166] E-mail this page to a friend or colleague! To print, use this version