Better control of liver enzymes saves lives of HIV patients, says University Of Pittsburgh

July 08, 2002

PITTSBURGH, July 8 - Mild to moderate elevations in two liver enzymes - increments that are commonly ignored by most physicians - are related to an increased risk of death in people with HIV, according to a University of Pittsburgh researcher who presented the findings July 8 at the XIV International AIDS Conference in Barcelona.

The enzymes are alanine transamine (ALT) and aspartamine transamine (AST).

"Up to one third of HIV patients have mild to moderate elevations in ALT and AST, yet physicians largely disregard the readings unless they are two to four times above the normal range," said Amy Justice, M.D., associate professor of health services research at the University of Pittsburgh Graduate School of Public Health, associate professor of medicine at the University of Pittsburgh School of Medicine, and staff physician at the Pittsburgh Veterans Administration Medical Center. "Our study shows that even patients whose elevations are mild to moderate have a death rate that is nearly twice that of patients with mid-range normal levels. This association with increased mortality suggests that any elevation in ALT and AST should be addressed."

Elevations in these enzymes signal injury to liver cells and, in some cases, to other cells in the body. The condition can result from highly active anti-retroviral therapy (HAART), viral hepatitis or alcohol abuse, all of which are toxic to liver cells. Liver failure is the most common cause of death in people with AIDS.

While ALT and AST testing is routine in monitoring of HIV patients, elevations are not typically addressed unless they are more than twice what is considered normal. The standard remedy for extremely high ALT and AST levels is to stop or change antiretroviral medications and to counsel patients to stop drinking alcohol. Mild to moderate elevations (0.5 up to 2 times the normal level) currently are not treated.

The Pittsburgh-led study was an analysis of data on more than 5,700 participants from two observational studies: Collaborations in HIV Research - U.S. (CHORUS), composed largely of white men who contracted HIV from homosexual activity, and women who contracted HIV from heterosexual activity or intravenous drug use; and the Veterans Aging Cohort Study (VACS), composed mainly of African American men who contracted HIV from heterosexual activity or intravenous drug use.

Study participants with mild to moderate elevations had an increased risk of death that was 1.73 times the risk of those with mid-range normal enzyme levels. Those with two or more times the normal enzyme levels had a 5.06 increased risk of death. Results were consistent in both the CHORUS and VACS cohorts.

"The fact that the findings were similar in two very different cohorts suggests that these results apply to all HIV patients," said Dr. Justice. "Furthermore, the fact that the most common current cause of death among people with HIV is liver failure suggests that liver injury may be a major limiting factor in the effectiveness of current HIV treatment."

In a related poster on display at the conference, Dr. Justice and colleagues relay findings from a study showing that incidence of liver cancer among HIV-positive veterans since the advent of HAART is nearly twice as high as it is for HIV-negative veterans. The researchers indicate that possible reasons for the increase may include drug toxicity and viral hepatitis.

"Chronic viral hepatitis is known to substantially increase the risk of liver cancer," said Dr. Justice. "Additional research must be done to determine whether HAART exacerbates this risk or only helps HIV-positive patients live long enough to suffer the consequences of other chronic diseases such as cancer."
-end-
The study on AST and ALT was a collaboration among the University of Pittsburgh, the Veterans Administration and the VACS and CHORUS project teams. Major funders for VACS include the National Institute on Alcoholism and Alcohol Abuse, the National Institute on Aging, the Robert Wood Johnson Foundation, the National Institute for Mental Health and the Veterans Administration. CHORUS is supported by GlaxoSmithKline, Inc.

CONTACT:
Frank Raczkiewicz
PHONE: (412) 624-2607
FAX: (412) 624-3184
E-MAIL: RaczkiewiczFA@msx.upmc.edu

University of Pittsburgh Medical Center

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.