Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Abstract

Elevated alanine aminotransferase (ALT) levels in Human Immunodeficiency Virus (HIV) infected people is a major concern in the world and especially in Africa. It may lead to liver failure and even death. Certain antiretroviral (ARV) drugs, such as nevirapine and efavirenz, are known to cause toxicity. Other causes of elevated ALT are viral hepatitis, the HIV virus itself and other drugs such as anti-tu-berculosis drugs and alcoholism. The study aimed at determining the prevalence of elevated ALT levels in HIV positive patients on antiretroviral therapy during the period 2013 to 2014. This was a retrospective study which included 267 patient records from Katutura and Windhoek Central hospitals in Windhoek, Namibia. The subjects' ages ranged from 21 to 82 years. The patients enrolled were on the first line treatment and their ALT levels were recorded at each monitoring period. ALT levels, viral hepatitis results and the antiretroviral therapy (ART) regimen were the most important aspects included in the study. Out of 267 patients, 18% had ALT elevation associated with grade 1 to 4 toxicity levels. The study found that 1.4% of patients developed severe liver toxicity (grade 3 and 4 toxicity). Toxicity occurred throughout the treatment period but was the highest at six months of treatment. Patients on nevirapine based regimens had lower toxicity compared to those receiving efavirenz based regimens. Patients who had HIV and viral hepatitis co-infection had high toxicity although the study found no severe hepatotoxicity in these patients.

Derangement of Liver Enzymes, Hyperglycemia, Anemia, and Associated Factors among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Regimen in Ethiopia: A Prospective Cohort Study

“…Concerning to mean value of ALT, there was slight increase at six-month follow-up compared to baseline mean value, but the difference was not significant (mean difference = +3:1, p = 0:148). This result is in line with the findings of the study conducted in Namibia [18,19]. In contrast, the result of the present study is different from the result of the study done in India [20].…”

“…Grades 3 and 4 hepatotoxicity was not found in this study. Regarding to elevated ALT at six-month follow-up, it was found in 3 (4.8%) of participants which is lower than the results of the studies done in Namibia, India, and China [18][19][20]22]. The discrepancy of the findings may be due to difference in baseline prevalence of elevated ALT, definition of elevated ALT, baseline sociodemographic, and clinical characteristics of study participants.…”

“…Particularly, in tenofovir disoproxil fumarate-based regimen hepatotoxicity was revealed in case reports [15][16][17]. Furthermore, various studies found elevation of liver enzymes in TDF-based regimen [18][19][20][21], and a study in China found that 48.1% of participants had hepatotoxicity following TDF-based regimen [22]. Hepatic histological damage is also found in animal study [23].…”