Hepatotoxicity and Associated Risk Factors in Hiv-Infected Patients Receiving Antiretroviral Therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia

Abstract

BackgroundIn Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).MethodsA cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.ResultsOut of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1–4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 –2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36–3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15–3.74) independently predicts the elevation of ALT.ConclusionsIn HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.

The Risk of Hepatotoxicity Associated with HAART/Anti-Tb Co-Treatment: A Case Control Study in a Central Ethiopian Referral Hospital

“…Female sex consideration in hepatotoxicity is important because pregnancy and related gynecological disorders could affect the incidence and the tolerability to DILI. Majority of male patients 28 (26.67%) and female 27 (25.7%) patients were on the WHO clinical stage III, which is similar to study conducted in Ethiopia (71.4%) [5].…”

“…Hepatotoxicity was confirmed based on laboratory criteria of 3 consecutive ALT measurements of >3X the Upper Limit of Normal (ULN) in the presence of clinical pictures of DILI and ALT measurements of great than 5 times the ULN in the absence of sign and symptoms. This finding is higher compared to a study conducted in Sweden and another study in Ethiopia [5,17] and still this figure is much higher than the 6% report from Tanzania [18]. These variations could be due to the fact that our study participants were all patients co-infected with TB/HIV and could also be due to the difference in sample size.…”

“…These variations could be due to the fact that our study participants were all patients co-infected with TB/HIV and could also be due to the difference in sample size. Further, the majority toxicity grade as per the WHO's criteria, was toxicity grade zero 84 (80%) unlike of other similar study conducted in Ethiopia [5].…”

“…However, along with these positivity outcomes, HAART is associated with a number of adverse reactions [3]. Drug-Induced Hepatotoxicity (DIH) is one of the overlapping side effects of both Anti-Retroviral Therapy (ART) and first line anti-TB drugs leading to interruption of treatment [4,5].…”

Incidence of Elevated Aminotransferases Levels among Patients Presenting with Hepatitis Syndrome in the Northwest Region of Cameroon

“…Thus their levels increase in chronic hepatitis B and C infections [12,13]. Liver enzyme alteration may either be the accompanying biochemical picture in a patient with symptoms or signs suggestive of liver disease or an isolated unexpected finding in a patient who has undergone a wide range of laboratory tests for a non-hepatic disease or used for little children [14].…”