Grade 3-4 liver enzyme elevation during HAART in HIV and hepatitis C co-infected adults.

AIM: To evaluate the incidence of grade 3-4 LEE in HIV/HCV co-infected patients after the introduction of HAART, the clinical significance to the patients and to determine any factors that could predict its development. METHODS: A retrospective cohort study of HIV/HCV co-infected adults in Pokdisus AIDS Clinic Cipto Mangunkusumo Hospital was conducted. All patients were antiretroviral naive and had never had interferon therapy before. Patients who started taking fist line combination therapy in Indonesia (NNRTI based regimen) from January 2004 to August 2006 and who were followed up for at least 6 months later were included in this study. RESULTS: A total of 59 grade 3-4 LEE (any ALT increase by > 5 times ULN or any increase of 100 U/L from baseline) developed in 284 patients during the follow up (20.8%). The median onset of grade 3-4 LEE was 20 weeks (min-max 2-80). Only 27.1% accompanied with symptoms. Two patients developed decompensated liver diseases, one of them ended with death. In 5 patients, grade 3-4 LEE coincided with nevirapine or efavirenz-related rashes. Fifty-two patients (88.1%) continued their antiretroviral regimen throughout the entire episode of grade 3-4 LEE. The median peak level of ALT was 2311 IU/L (IQR, 174-327). CONCLUSION: Lower baseline ALT was the only factor significantly correlated with grade 3-4 LEE in this study.