title: Hepatotoxicity from first line antiretroviral therapy: an experience from a resource limited setting.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has been associated with liver toxicity. The role of monitoring for liver toxicity has not been well studied in resource-limited settings (RLS).
  
  
  OBJECTIVE
  To determine the background prevalence and incidence of liver injury and describe the associated signs and symptoms of acute hepatitis after initiating HAART; and to determine the role of liver enzyme tests in monitoring hepatotoxicity.
  
  
  METHODS
  In this prospective study, in Mulago Hospital AIDS Clinics, we consecutively enrolled adult patients initiated on one of three first line HAART regimens [Stavudine (d4T)-Lamivudine (3TC) and nevirapine (NVP); Zidovudine (AZT)-3TC and Efavirenz (EFV) or d4T-3TC-EFV]. We monitored ALT (alanine aminotransferase) and clinical evidence of acute hepatitis at baseline, 2(nd), 6(th), 10(th) and 14(th) week of therapy.
  
  
  RESULTS
  Two hundred and forty HIV-positive HAART- naïve patients were enrolled in the study. The baseline prevalence of transaminitis was 1.7% with an incidence of 4.2% at 14 weeks. Grade 3-4 hepatotoxicity was documented in 1.3%. Jaundice was seen in grade 2-4 ALT elevations. Being on concurrent HAART and antituberculous drugs was associated with grade 2-4 toxicity compared to those who were only on HAART [OR; 16.0 (95% CI; 2.4-104.2)].
  
  
  CONCLUSIONS
  Incidence of severe hepatotoxicity within three months of first-line antiretroviral therapy was low, suggesting that routine measurement of transaminases may not be necessary in all patients initiating HAART in RLS. Routine measurement may be important in following patients on HAART and concurrent TB treatment as well as those with jaundice to avoid missing hepatotoxicity.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. rkalyes@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Kalyesubula
authors.forename: M
authors.initials: M
authors.lastname: Kagimu
authors.forename: K C
authors.initials: KC
authors.lastname: Opio
authors.forename: R
authors.initials: R
authors.lastname: Kiguba
authors.forename: C F
authors.initials: CF
authors.lastname: Semitala
authors.forename: W F
authors.initials: WF
authors.lastname: Schlech
authors.forename: E T
authors.initials: ET
authors.lastname: Katabira
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008099:Liver / Q000187:drug effects*; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000410:Alanine Transaminase