High Human Immunodeficiency Virus (HIV) Viral Load and Coinfection with Viral Hepatitis Are Associated with Liver Enzyme Abnormalities among HIV Seropositive Patients on Antiretroviral Therapy in the Lake Victoria Zone, Tanzania

Abstract

Background. Liver enzymes abnormalities have been found to be common among patients on antiretroviral treatment (ART). Apart from the effects of ART on these changes, other factors that can potentially contribute to the abnormal levels of these enzymes have been found to vary in different geographical locations. This study investigated factors associated with liver enzymes abnormalities among human immunodeficiency virus (HIV) infected individuals on ART from the Lake Victoria zone, Tanzania. Methods. A cross-sectional study involving a total of 230 sera from HIV seropositive patients from different regions of the Lake Victoria zone was carried out in July 2017. All samples with required variables/parameters such as age, sex, ART regimen, and residence were serially included in the study. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) detection and liver enzymes assays (alanine transaminase (ALAT) and aspartate transaminase (ASAT)) were assessed following the standard procedures. Data were analyzed by using STATA version 13. Results. The median age of the study participants was 38 (interquartile range [IQR]:30-48) years. The overall prevalence of abnormal liver enzymes was 43.04% (99/230, 95% CI: 36.6-49.3). A total of 26.09% (60/230) had elevated ASAT while 23.9% (55/230) patients had elevated ALAT levels. ASAT levels were significantly high among patients with high HIV viral load (P= 0.002) while ALAT levels were significantly high among those coinfected with hepatitis C virus (P=0.017) and hepatitis B virus (P<0.001). Conclusion. A significant proportion of HIV seropositive individuals on ART have abnormal levels of liver enzymes, which is significantly associated with high HIV viral load and viral hepatitis. This calls for the need to emphasize screening of viral hepatitis and provision of appropriate management among HIV seropositive individuals in this setting.

Prevalence of elevated liver transaminases and their relationship with alcohol use in people living with HIV on anti-retroviral therapy in Uganda

“…In this Ugandan cohort of PLWH receiving ART enriched for persons consuming alcohol, the proportion of individuals with pre-IPT transaminase elevations, i.e. those �1.25X the ULN, (19%) consistent with previous studies of PLWH which ranged from 13-43% [9,[11][12][13][14][15][16]. In addition, we observed very few (1%) transaminase elevations in the severe range, i.e.…”

“…Thus pre-IPT transaminase elevations are important to consider in populations that are candidates for IPT. Transaminase elevation prevalence is believed to be 10-22% in the general population [10] and 13-43% of PLWH, independent of ART status [9,[11][12][13][14][15][16]. Alcohol is known to be hepatotoxic, and data from studies of PLWH in the US suggest heavy alcohol use is associated with increased transaminases [17,18].…”

“…Yet the proportion of elevated transaminases among PLWH who use alcohol in TB endemic settings has not been established. Other observed contributors to transaminase elevations include ART use, male sex, viral coinfections (hepatitis B and C) [11], and liver diseases such as non-alcoholic fatty liver disease (NAFLD) [12,13]. Thus, we evaluated the prevalence of elevated liver transaminases in PLWH on ART in Uganda and whether factors including current alcohol use (the main exposure of interest), sex, ART regimen, or body mass index (BMI) (an indicator of NAFLD), were associated with pre-IPT transaminase elevations.…”

Changes in liver function test levels in HIV patients undergoing highly active antiretroviral therapy (HAART). Longitudinal study in Lima, Peru

“…A diferencia de estudios previos (12)(13)(14)(15)(16)(26)(27)(28)(29), nuestros resultados realizados con tres controles de niveles enzimáticos hepáticos dentro del Programa hospitalario demostraron una reducción de ALT entre el primer control y el tercer control serológico, coincidiendo con el estudio de seguimiento de Mgogwe et al, (30) en pacientes africanos VIH positivos con la TARGA activa (Figura 3). Esta reducción podría deberse a numerosas condicionantes como el esquema de la TARGA y el tiempo de uso de cada grupo de pacientes analizados en esta cohorte, al uso de otros fármacos con potencial hepatatoxicidad, a coinfecciones virales, al estatus inmunológico, entre otros.…”

“…(24,25). El estudio de Sunny et al, (14) en India ha demostrado incrementos significativos de la concentración de ALT (pero no AST), mientras que el estudio de Iddi et al, (26) en Tanzania demostró el incremento de ambos marcadores en pacientes con VIH positivos con la TARGA activo.…”