Alanine aminotransferase levels are not significantly elevated in patients with HIV/HBV co-infection and lamivudine resistance

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http://ijsa.rsmjournals.com/cgi/content/abstract/19/11/780

Int J STD AIDS 2008;19:780-781

doi:10.1258/ijsa.2008.008020

Alanine aminotransferase levels are not significantly elevated in patients with

HIV/HBV co-infection and lamivudine resistance

D Bhattacharya MD * , D Katzenstein MD *, A Wong , D Israelski MD * , J C

Imperial MD **, E B Keeffe MD ** and R M Donovan PhD

* Division of Infectious Diseases, Stanford University School of Medicine,

Stanford, CA 94305; San Mateo Clinical AIDS Program, San Mateo, CA 94305;

Division of Infectious Diseases, Geffen School of Medicine, University of

California at Los Angeles, Los Angeles, CA 90095, USA; Viral and Rickettsial

Diseases Laboratory, Department of Health Services, Richmond, 94804; ** Division

of Gastroenterology and Hepatology, Stanford University School of Medicine,

Stanford 94304, USA

Correspondence to: Debika Bhattacharya, Division of Infectious Diseases,

Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 37-121 CHS, Los

Angeles, CA 90095, USA Email: debikab@...

In hepatitis B virus (HBV) monoinfection, alanine aminotransferase (ALT) levels

are linearly correlated with HBV DNA levels and lamivudine resistance. In human

immunodeficiency virus (HIV)/HBV co-infection, little is known about the

association between ALT, HBV DNA, and lamivudine resistance. We assessed HBV

DNA, lamivudine resistance and ALT levels in 45 time points in 11 patients with

HIV/HBV co-infection during lamivudine-containing antiretroviral therapy. High

HBV DNA levels (>106 copies/mL) and lamivudine resistance developed in 45% and

91% of patients, respectively. However, ALT levels were not elevated in the

setting of high HBV DNA levels (mean ALT, 48 IU/mL) or lamivudine resistance

(mean ALT, 44 IU/mL). HBV viraemia and lamivudine resistance during extended

lamivudine-containing antiretroviral therapy are common in HIV/HBV co-infection,

occurring in the absence of significant ALT elevations. In HIV/HBV co-infection,

measurement of HBV DNA and HBV resistance mutations may identify HBV virological

failure before biochemical changes and should be routinely used in the

management of HIV/HBV co-infection.