title: Hepatotoxicity and associated risk factors in HIV-infected patients receiving antiretroviral therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia.
abstract: BACKGROUND
  In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).
  
  
  METHODS
  A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.
  
  
  RESULTS
  Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1-4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 -2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36-3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15-3.74) independently predicts the elevation of ALT.
  
  
  CONCLUSIONS
  In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.
authors.affiliation: Department of Medical Microbiology, Immunology and Parasitology, Bahirdar University, Ethiopia.
authors.forename: Wondemagegn
authors.initials: W
authors.lastname: Mulu
authors.forename: Bokretsion
authors.initials: B
authors.lastname: Gidey
authors.forename: Ambahun
authors.initials: A
authors.lastname: Chernet
authors.forename: Genetu
authors.initials: G
authors.lastname: Alem
authors.forename: Bayeh
authors.initials: B
authors.lastname: Abera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood* / Q000378:metabolism; D000428:Alcohol Drinking / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000097:blood / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000201:enzymology / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000378:metabolism; D055815:Young Adult
chemical_list: D012367:RNA, Viral; D000410:Alanine Transaminase
keywords: ALT; ART; Bahir Dar; Ethiopia; HIV