Low rates of hepatotoxicity in HIV-infected children on anti-retroviral therapy with and without isoniazid prophylaxis.
This study investigates the incidence of hepatotoxicity in HIV-infected children during anti-retroviral therapy (ART) and the impact of concomitant use of isoniazid preventive therapy. It is a retrospective cohort analysis of HIV-infected children who commenced ART or were followed up between September 1998 and November 2005. Alanine transferase levels were measured at baseline, at 1, 3 and 6 months and then 6 monthly thereafter. Of the 598 children included in the study, 425 were taking ART alone, 73 ART and isoniazid, 39 isoniazid alone and 61 neither isoniazid nor ART. There was no increased risk of hepatotoxicity with ART with or without isoniazid compared to the control group over a 2-year period. Grade 3 or 4 ALT elevations occurred in 19 (3.4%) children, with no cases of fulminant hepatic failure. Severe hepatic events are uncommon in children on ART or isoniazid. There is no increased risk of hepatotoxicity with ART and concurrent isoniazid preventive therapy.
Gray
Diane
D
Paediatric HIV Service, Groote Schuur Hospital, Cape Town, South Africa. diane@kidzpositive.org
Nuttall
James
J
Lombard
Carl
C
Davies
Mary-ann
MA
Workman
Lesley
L
Apolles
Patti
P
Eley
Brian
B
Cotton
Mark
M
Zar
Heather J
HJ
Zar
Heather
H
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D007538:Isoniazid / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects; D017093:Liver Failure / Q000139:chemically induced*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D007538:Isoniazid