Original Article

Determinants of Elevated Alkaline Phosphatase in Patients Infected with HIV

Authors: Brook T. Alemu, MA, MPH, Stephanie B. Troy, MD, Hind A. Beydoun, PhD, MPH, Muge Akpinar-Elci, MD, MPH, Tina D. Cunningham, PhD

Abstract

Objectives: A retrospective cross-sectional study was performed to assess the prevalence of elevated alkaline phosphatase (ALP) in patients infected with human immunodeficiency virus (HIV) and to determine the relation between ALP and specific antiretroviral therapy (ART).

Methods: A total of 2990 patients were included in this study. Data were collected from a major academic institution’s HIV clinic using the most recent searchable values from patients’ medical records. Included patients were 18 to 89 years old, had HIV, and their ALP results were available. Elevated ALP was defined as ALP >120 IU/L. Logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for predictors of elevated ALP level.

Results: In our total population of 2990, 15.4% (n = 459) had elevated ALP. In the bivariate analyses, older age (≥60 years; OR 4.1, 95% CI 2.6–6.4), female sex (OR 1.6, 95% CI 1.3–1.9), Other race (not African American) vs white (OR 1.9, 95% CI 1.8–3.3), elevated creatinine (OR 2.9, 95% CI 2.1–4.1), laboratory evidence of liver disease (OR 2.1, 95% CI 1.7–2.6), CD4 count <200 cells per cubic millimeter (OR 2.5, 95% CI 2.0–3.2), hepatitis C infection (OR 1.9, 95% CI 1.4–2.5), laboratory markers of bone turnover (OR 1.9, 95% CI 1.2–3.1), and non-nucleoside reverse-transcriptase inhibitors use (OR 1.2, 95% CI 1.02–1.15) were significantly associated with elevated ALP. Only the association with laboratory markers of bone turnover remained significant in the multivariate analysis, however.

Conclusions: The results suggest that comorbidities and demographic variables have stronger associations with elevated ALP than specific antiretroviral therapy. Future research should be conducted to define the clinical significance of elevated ALP among patients infected with HIV.

 

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References

1. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2014. http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Published November 2015. Accessed May 20, 2016.
 
2. Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV-United States, 2011. MMWR Morb Mortal Wkly Rep 2014;63:1113-1117.
 
3. Palmisano L, Vella S. A brief history of antiretroviral therapy of HIV infection: success and challenges. Ann 1st Super Sanita 2011;47:44-48.
 
4. Cohen MS, Chen YQ, Mccauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493-505.
 
5. Dieffenbach CW, Fauci AS. Thirty years of HIV and AIDS: future challenges and opportunities. Ann Intern Med 2011;154:766-771.
 
6. Montessori V, Press N, Harris M, et al. Adverse effects of antiretroviral therapy for HIV infection. CMAJ 2004;170:229-238.
 
7. Fux CA, Rauch A, Simcock M, et al. Tenofovir use is associated with an increase in serum alkaline phosphatase in the Swiss HIV cohort study. Antivir Ther 2008;13:1077-1082.
 
8. Piso RJ, Rothen M, Rothen JP, et al. Markers of bone turnover are elevated in patients with antiretroviral treatment independent of the substance used. J Acquir Immune Defic Syndr 2011;56:320-324.
 
9. Kinai E, Hanabusa H. Renal tubular toxicity associated with tenofovir assessed using urine-beta 2 microglobulin, percentage of tubular reabsorption of phosphate and alkaline phosphatase levels. AIDS 2005;19:2031-2033.
 
10. Welz T, Childs K, Ibrahim F, et al. Efavirenz is associated with severe vitamin D deficiency and increased alkaline phosphatase. AIDS 2010;24:1923-1928.
 
11. Garnero P. Bone markers in osteoporosis. Curr Osteoporos Rep 2009;7:84-90.
 
12. Friedman LS, Keefe EB. Approach to the patient with abnormal liver biochemical and function tests. http://www.uptodate.com/contents/liver-biochemical-tests-that-detect-injury-to-hepatocytes?source=see_link&ampanchor=H2#H2. Published November 12, 2013. Accessed December 23, 2015.
 
13. Hosmer DW, Taber S, Lemeshow S. The importance of assessing the fit of logistic regression models: a case study. Am J Public Health 1991;81:1630-1635.
 
14. Rasmussen TA, Jensen D, Tolstrup M, et al. Comparison of bone and renal effects in HIV-infected adults switching to abacavir or tenofovir based therapy in a randomized trial. PLoS One 2012;7:e32445.
 
15. Mayo Medical Laboratories. Alkaline phosphatase, serum. http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8340. Accessed January 22, 2016.