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

Abstract

Background Isoniazid preventive therapy (IPT) reduces tuberculosis reactivation and mortality among persons living with HIV (PLWH), yet hepatotoxicity concerns exclude “regular and heavy alcohol drinkers” from IPT. We aimed to determine the prevalence of elevated liver transaminases among PLWH on antiretroviral therapy (ART) who engage in alcohol use. Setting The Immune Suppression Syndrome Clinic of Mbarara, Uganda. Methods We defined elevated liver transaminases as ≥1.25 times (X) the upper limit of normal (ULN) for alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST). We evaluated the associations of current alcohol use and other variables of interest (sex, body mass index, and ART regimen) with elevated transaminases at study screening, using multivariable logistic regression to obtain adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results Among 1301 participants (53% female, median age 39 years, 67.4% current alcohol use), 18.8% (95% CI: 16.8–21.1) had elevated transaminases pre-IPT, with few (1.1%) severe (≥5X the ULN). The proportion with any elevation among those currently using alcohol and those abstaining was 22.3% and 11.6%, respectively (p<0.01). In multivariable analyses, those currently using alcohol had higher odds of elevated transaminases compared to those abstaining (aOR 1.65, 95% CI 1.15–2.37) as did males compared to females (aOR 2.68, 95% CI 1.90–3.78). Conclusions Pre-IPT elevated transaminases among PLWH receiving ART were common, similar to prior estimates, but severe elevations were rare. Current drinking and male sex were independently associated with elevated transaminases. Further research is needed to determine the implications of such transaminase elevations and alcohol use on providing IPT.

Transaminitis prevalence among HIV-infected adults eligible for tuberculosis preventive therapy

“…To ensure safe scale-up of TPT, careful selection of patients for TPT and close monitoring for signs and symptoms of hepatotoxicity during TPT remains essential. Our results are consistent with prior studies reporting severe transaminitis to be rare among a general population of PWH regardless of ART status [4,8–12]. However, direct comparison with other studies is difficult as definitions of elevated transaminases varied.…”

“…Although several studies have reported transaminitis prevalence among PWH [4,[8][9][10][11][12], the proportion of PWH ineligible for TPT because of elevated liver enzymes is unclear. Characterizing the burden of transaminitis among PWH without TB (i.e.…”

Alcoholic Liver Biomarkers: Determinants for Admission to Rehabilitation Centres During the Covid 19 Period in Kenya

“…A study in US reported on the normal ranges for transaminase values for the biomarkers of liver function as, AST 0 to 35 IU/L, ALT as 0 to 45 IU/L, GGT as 0 to 30 IU/L, Bilirubin as 2 to 17 micromoles/L, Albumin as 40 to 60 g/L and Prothrombin time as 10.9 to 12.5 seconds. Shreevastva, Pandeya and Mishra (2017) reported that AST or ALT when elevated rarely exceed 300 IU/L in ALI 14,15 .…”

Alcohol Use and the Risk of Communicable Diseases

“…Less is known about the role of alcohol in TB preventive therapy. Until recently, the only regimen available for prevention was 6-12 months of isoniazid with rare but recognized hepatic toxicity that can be exacerbated by alcohol use [117][118][119][120][121]. The balance between the benefits of preventing TB, with its individual and public health implications, against the risk of individual toxicity is currently being explored, considering the potential lower risk associated with shorter course regimens [122,123].…”

“…Alcohol use complicates TB treatment for drug-susceptible and drug-resistant TB [102]. Frequent coinfection with hepatitis C and/or HIV increases the risk of hepatotoxicity [121,131,132]. Interactions between alcohol and anti-tuberculous medications are well established.…”