[MoOrB1058] HIV survival: liver function tests independently predict survival

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] HIV survival: liver function tests independently predict survival

[AUTHOR(S):] A C Justice, J H Wagner, K A McGinnis, J Conigliaro, R Bonomo¹, G P Fusco², D T Dieterich³, S L Becker⁴, K A McGinnis, J Conigliaro, R Bonomo, M Rodriguez-Barradas

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1058

BACKGROUND: Whether by HAART, viral hepatitis, or alcohol, transaminitis (elevated ALT and AST) is common among those with HIV infection. We used data from VACS 3 and CHORUS to determine the importance of transaminitis in predicting survival after adjusting for CD4 count and HIV-1 RNA.

METHODS: The VACS 3 and CHORUS cohorts have been described in detail. At the time of analysis, VACS 3 has data on CD4, viral load (VL), ALT (SGPT) and AST (SGOT) on 773 patients, 56 have died. VACS 3 patients are predominantly male (99%), African American (55%), and contracted HIV via IV drug use or heterosexual exposure (53%). CHORUS had data on 4946 patients, 280 have died. CHORUS subjects are predominantly male (91%), white (75%), and men who have sex with men (87%). Variables were transformed to approximate normal distributions (table). Cox proportional hazards survival models were used to measure variable importance. ROC area (C statistic) was used to compare discrimination of the models. Linear regression was used to determine whether Hepatitis C infection mediates transaminitis.

RESULTS: In unadjusted analyses, CD4, VL, and AST were significant predictors of survival in both cohorts (p<0.001). ALT was significant only in CHORUS (p<0.001). A model restricted to CD4 and VL demonstrated discrimination in both CHORUS and VACS 3 (ROC: 0.78, 0.63). A model restricted to AST and ALT also demonstrated discrimination in both (ROC: 0.70, 0.62). The full model was superior (ROC: 0.82, 0.71)

		CHORUS		VACS 3
Variable	Transformation	HR	p	HR	P
CD4 Count	Square Root	0.89	<0.001	0.94	0.009
Viral Load	Log₁₀	1.37	<0.001	1.35	0.008
AST	Natural log	3.21	<0.001	2.59	<0.001
ALT	Natural log	0.49	<0.001	0.44	0.002

In both, hepatitis C was associated with increased AST (p<0.001) and ALT (p<0.001), but not with survival. An important strength of this result is consistency across two diverse cohorts.

CONCLUSIONS: Transaminitis is a major determinant of survival and should be carefully considered in all phases of HIV therapy.

Presenting author: A C Justice

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1 U. of Pittsburgh, GlaxoSmithKline, PO Box 13398, Research Triangle Park, NC 27709-3398, United States

2 GlaxoSmithKline, RTP, United States

3 Liberty Medical, New York, United States

4 Pacific Horizon Med Group, San Francisco, United States

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MoOrB1058