Asymptomatic elevations of liver function tests (LFTs) have been reported in a large percentage of HIV-infected adults but less is known about the pediatric HIV population. We reviewed the records of 125 children who had received ≤ 6 weeks of therapy for HIV followed at the Pediatric Branch, NCI between 2/87 and 1/95. Patient records were evaluated for the presence or absence of transaminitis, defined as an increase in alanine aminotransferase(ALT) and/or aspartate aminotransferase (AST) to > 5 times the upper limit of normal. 67 of the patients acquired HIV perinatally, 56 from blood product administration and in 2 the route of acquisition could not be determined. 81 were male and 44 female. Patients were initially divided into two groups: those who presented to the Pediatric Branch with transaminitis and those who did not. The latter group was then further divided into those who developed transminitis while receiving antiretroviral therapy and those whose LFTs remained less than five times the upper limit of normal throughout therapy. For each patient, the presence or absence of potentially contributing factors was determined: administration of common antimicrobial medications and antiretroviral agents; infection with cytomegalovirus or a hepatitis virus; absolute CD4 cell count and CD4%; 1994 revised CDC classification; presence of opportunistic infections. Of the 125 children, 64 (51%) had one or more episodes of transaminitis with an average AST=317 and ALT=233. The only factors even modestly associated with transaminitis at NCI presentation were: CDC Class C, male sex, and use of ketoconazole or bactrim (P=0.03-1.2). Associated with transaminitis during antiretroviral therapy were pre-therapy cytomegalovirus infection (P=0.007) and possibly use of erythromycin or ketoconazole and not receiving IVIG (P=0.02-0.09). Of the antiretroviral therapeutic agents evaluated, use of zidovudine (P=0.05) and didanosine(P=0.06) were associated with elevated LFTs.
