Risk for Incident Liver Damage in Patients With HIV on Antiretroviral Therapy

human liver
human liver
Researchers assessed the risk for liver damage among patients with HIV-1 monoinfection receiving antiretroviral therapy.

Patients with HIV-1 monoinfection at increased risk for liver damage should be closely monitored while undergoing antiretroviral therapy (ART), including those with normal liver function prior to ART initiation. These findings were published in HIV Medicine.

 Researchers retrospectively analyzed clinical data from adult patients diagnosed with HIV-1 infection who started ART between January and December 2017. Eligible patients included those who had not previously received ART with normal liver function at baseline. Patients were followed for 3 years, and the researchers calculated the incidence rate (IR) of liver damage via Cox regression survival analyses at 1, 2, and 3 months after ART initiation, and at 3-month intervals thereafter.

A total of 382 patients were included in the final analysis, of whom 361 (94.5%) were men, 21 (5.5%) were women, and the median age was 33 (IQR, 26-44) years. Following ART initiation, laboratory findings obtained within the follow-up period disclosed abnormal liver function in 235 patients and normal liver function in 147.

Overall, the IR liver damage among patients with abnormal liver function was 27.23% (IQR, 26.38-28.72). Further analysis showed that most patients had grade 1 liver damage (IR, 22.13%; IQR, 21.06-24.04), followed by grade 2 liver damage (IR, 3.40%; IQR, 3.19-4.26).

In regard to patient characteristics, the researchers found that both BMI and HIV-1 viral load were statistically significantly increased among patients with incident liver damage following ART initiation. No statistically significant differences in sex, age, CD4+ T-cell count, marital status, degree of education, or infection route were observed among patients with vs without incident liver damage. Although concentrations of alanine aminotransferase (ALT) were statistically significantly increased at baseline among patients who developed liver damage, no significant differences in concentrations of aspartate aminotransferase and total bilirubin were observed between those with vs without liver damage. The researchers performed multivariate Cox regression and found that baseline ALT concentration was an independent risk factor for incident liver damage (hazard ratio [HR], 1.071; P =.016).

The researchers assessed differences in ART regimens among the patients. They found that the risk for incident liver damage was increased among patients whose ART regimens comprised lamivudine/zidovudine plus efavirenz (HR, 5.123; P =.005).

The study was limited by its small sample size, single-center setting, and the inability to assess the incidence of liver fibrosis due to insufficient data. The researchers also noted that the small number of patients on integrase strand transfer inhibitors (INSTI) limited their ability to determine the risk for liver damage associated with different INSTIs.

According to the researchers, “based on current evidence, there does not seem to be an ideal (ART) regimen that can completely avoid the risk [for] liver damage.” They concluded, “…patients with HIV-1 infection should be well informed regarding the need for changes in diet and lifestyle prior to initiating ART, and they should undergo regular monitoring of ART efficacy and liver function.”


Huang H, Song B, Gao L, et al. Incidence of and risk factors for liver damage in patients with HIV-1 mono-infection receiving antiretroviral therapy. HIV Med. Published online March 23, 2022. doi: 10.1111/hiv.13245