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
Contact: Kathryn Duda
University of Pittsburgh Medical Center