We sought to describe liver enzyme elevation (LEE) rates and risk factors; and differentiate obstetrical from other causes among pregnant HIV-infected women.METHODS:
A retrospective chart review was conducted for all HIV-infected women delivering at two hospitals in Bronx, NY from 2005 to 2014. We collected all alanine aminotransferase results during pregnancy and graded LEE. Charts were reviewed in detail and cases classified according to attributed cause of LEE. Associations between LEE and maternal characteristics were studied using multivariate logistic regression.RESULTS:
We included 496 pregnancies. LEE was observed in 69 patients (13.9%), among which 14 were severe (grade 3–4). Most LEE occurred in the 3rd trimester (n=36). The cause of LEE was attributed to preeclampsia (n=6), active hepatitis (n=4), cholestasis of pregnancy (n=3), or non-obstetrical causes (n=11). After exclusion of these cases, unexplained LEE was significantly associated with protease inhibitor (PI) use (vs no PI): 12% vs 1.3%, P=.02, and age (P=.02) in multivariate analysis. There was a non-significant trend for black ethnicity (P=.07) and preterm birth (P=.06). Among these unexplained cases: LEE decreased spontaneously after delivery with no change in antiretroviral regimen in 19 cases, LEE decreased spontaneously before delivery (n=12), or after antiretroviral therapy was changed (n=3). In some cases, the cause of LEE could not be differentiated from atypical preeclampsia or cholestasis and delivery was induced (n=4).CONCLUSION:
The rate of LEE among HIV-infected women is high, and can affect obstetrical management. Mechanisms involved in the association with PI use should be further studied.