Prevalence and risk factors for abnormal liver stiffness in HIV-infected patients without viral hepatitis coinfection: Role of didanosine

Abstract

Background: Unexpected cases of severe liver disease in. HIV-infected patients have been reported and an association with didanosine (ddI) has been suggested. Transient elastography (TE) might detect patients harbouring such a condition. Our objective was to search for the presence of abnormal liver stiffness (LS) in a cohort of HIV-infected patients without HBV or HCV coinfection and to assess the related factors. Methods: A cross-sectional prospective study was conducted. LS was assessed by TE in 258 HIV-infected patients without HBV or HCV coinfection and with no evidence of acute hepatotoxicity or other origins of liver disease. LS values ≥7.2 kPa were considered abnormal. Multivariate analyses were performed to identify factors associated with abnormal LS. Results: Abnormal LS was observed in 29 (11.2%) patients. A total of 18 (16.4%) patients previously treated with ddI and 11 (7.4%) of those who never received ddI had LS values ≥7.2 kPa (P=0.02). The prevalence of abnormal LS was higher in patients previously treated with abacavir than in those who had never received abacavir (15 [21.7%] versus 14 [7.4%]; P=0.001). After multivariate analyses, age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.002.1.1; P=0.004) alcohol intake >50 g/day (AOR 7.2, 95% CI 2.6.19.7; P<0.0001), CD4+ T-cell count <200 cells/ml (AOR 3.4, 95% CI 1.06.11.007; P=0.03), time on ddI treatment (AOR 1.31, 95% CI 1.12.1.52; P=0.001) and previous abacavir exposure (AOR 3.01, 95% CI 1.18.7.67; P=0.02) were independently associated with abnormal LS. Conclusions: The prevalence of abnormal LS in HIV-infected patients without HBV or HCV coinfection is substantial. Long-term exposure to ddI is a major cause of liver damage in these patients. ©2010 International Medical Press.