HIV monitoring guidelines recommend 3-to-12 monthly monitoring of LFTs in HIV-infected patients. Liver-related deaths account for 10–15% of mortality in patients with HIV-infection. Draft NICE guidance, covering the identification of chronic liver disease, is under consultation.Methods
200 HIV-infected patients were randomly selected from a cohort of 1000 patients. Those patients who were not engaged in care (i.e. less than 2 out-patient appointments in the past 12 months) or not on ARVs were excluded. Demographics, lifestyle factors and laboratory parameters were recorded. Patients at greatest risk of liver cirrhosis were screened using transient elastography.Results
Of the 161 HIV-infected patients on ARVs, 49 (30%) had a raised AST or ALT within the preceding year. Only 105 (65%) had a documented alcohol history. Of patients with elevated transaminases, the cause was already established in 21/49 (43%). Factors included alcohol, IM testosterone, viral hepatitis, cryptosporidium infection and hepatotoxic medication. 12 patients were found to have an AST-to-platelet ratio index (APRI) of greater than 0.7. Of these the causes identified included: 4 hepatitis C co-infected, 1 hepatitis B co-infected, 2 alcohol related, 1 Budd Chiari awaiting liver transplant, 2 medication related and 2 not established. Patients with raised transaminases were offered metabolic risk factors screening and transient elastography.Discussion
There is a small but significant burden of liver disease in patients on ARVs. Lifestyle counselling, to reduce harmful alcohol consumption and viral hepatitis infection could be improved. Implementation of NICE guidelines may improve the diagnosis of cirrhosis.