Association of Abnormal Liver Function Parameters with HIV Serostatus and CD4 Count in Antiretroviral-Naive Rwandan Women.
We determined the associations of HIV infection/CD4 count with markers of hepatocellular damage [elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and liver synthetic function (decreased albumin) in HIV-infected (HIV(+)) antiretroviral therapy (ART)-naive and uninfected (HIV(-)) Rwandan women. In 2005, 710 HIV(+) ART-naive and 226 HIV(-) women enrolled in the Rwanda Women's Interassociation Study and Assessment. Liver enzymes were measured with abnormality defined as either AST or ALT ≥1.25 times the upper limit of normal. Low serum albumin level was defined as <3.5 g/dl. Multivariable logistic regression analysis identified independent predictors of elevated AST/ALT and low serum albumin. HIV(-) women had the lowest prevalence (6.6%) of abnormal AST/ALT, with the highest prevalence (16.4%) in HIV(+) women with CD4 <200 cells/μl (p=0.01). The odds of having serum albumin <3.5 g/dl was 5.7-fold higher in HIV(+) than HIV(-) women (OR=5.68, 95% CI: 3.32-9.71). The risk of low albumin decreased from low to high CD4 count, with OR=2.62, 95% CI: 1.66, 4.14 and OR=1.57, 95% CI: 1.01, 2.43 in HIV(+) women with a CD4 count <200 and 200-350 cells/μl, respectively vs. HIV(+) with CD4 >350 (p<0.001 and p<0.05 for all comparisons). Our findings suggest that HIV-associated liver damage may occur in ART-naive patients. Although liver abnormality prevalences in this cohort of HIV-infected Rwandan women are less than reported in developed countries, caution is needed for risk assessment measures to monitor and screen HIV-infected patients pre- and post-ART initiation in African clinical settings to curtail potential risks associated with HIV infection.
1 Regional Alliance for Sustainable Development (RASD Rwanda) , Kigali, Rwanda .
Jean Claude
JC
Dusingize
2 The State University of New Jersey , New Brunswick, New Jersey.
Donald R
DR
Hoover
3 School of Health Sciences and Practice, New York Medical College , New York, New York.
Qiuhu
Q
Shi
1 Regional Alliance for Sustainable Development (RASD Rwanda) , Kigali, Rwanda .
Eugene
E
Mutimura
4 King Faisal Hospital , Kigali, Rwanda .
Emmanuel
E
Rudakemwa
5 Centre Hospitalier Universitaire de Butare , Huye, Rwanda .
Victorien
V
Ndacyayisenga
4 King Faisal Hospital , Kigali, Rwanda .
Léonard
L
Gakindi
6 Albert Einstein College of Medicine , Bronx, New York.
Michael
M
Mulvihill
1 Regional Alliance for Sustainable Development (RASD Rwanda) , Kigali, Rwanda .
Jean D'Amour
JD
Sinayobye
4 King Faisal Hospital , Kigali, Rwanda .
Emmanuel
E
Musabeyezu
6 Albert Einstein College of Medicine , Bronx, New York.
Kathryn
K
Anastos
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000503:physiopathology; D008111:Liver Function Tests; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase