Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda.
Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting.
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. pocama@idi.co.ug
P
P
Ocama
B
B
Castelnuovo
M R
MR
Kamya
G D
GD
Kirk
S J
SJ
Reynolds
A
A
Kiragga
R
R
Colebunders
D L
DL
Thomas
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001219:Aspartate Aminotransferases / Q000097:blood*; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014454:Uganda
D019380:Anti-HIV Agents; D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases