title: The effect of highly active antiretroviral therapy on liver function in human immunodeficiency virus-infected pediatric patients with or without hepatitis virus co-infection.
abstract: BACKGROUND
  Co-infection of hepatitis virus is common in human immunodeficiency virus (HIV) infected adults in China. But little is known about hepatitis virus co-infection in pediatric HIV-infected subjects. The study aimed to investigate the impact of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) co-infection and highly active antiretroviral therapy (HAART) on liver function of pediatric HIV-infected subjects.
  
  
  METHODS
  A cohort study including 101 pediatric HIV-infected subjects with HBV/HCV co-infection and 44 pediatric comparators with HIV mono-infection was carried out in Henan Province of China from September 2011 to September 2012. All patients received HAART for 1-year. HBV and HCV infection was determined by antibody tests. HIV RNA load, CD4(+) T-cell counts and liver function were determined before and after HAART. The Student's t-test or a one-way ANOVA was used for normally distributed values and A Mann-Whitney U-test was performed for values without normal distribution using SPSS statistical package 18.0 (SPSS Inc.).
  
  
  RESULTS
  After HAART for 1-year, the median levels of viral load were decreased to lower limit of detection in 90.34% pediatric HIV-infected subjects with/without HBV/HCV co-infection (P < 0.001), and CD4(+) T-cell counts increased significantly (P < 0.001). Compared with the pre-HAART, mean level of alanine aminotransferase (ALT) in each group had a significant increase after HAART (P < 0.01). The mean levels of ALT and aspartate aminotransferase (AST) in nevirapine (NVP) based HAART group increased significantly after HAART (P < 0.01). Mean change values of ALT and AST were significantly higher in the NVP based regimen group than in the efavirenz (EFV) based regimen group (P < 0.01). For HIV/HBV/HCV co-infected patients, mean change values of ALT and AST in NVP-based HAART group was significantly higher than that in EFV-based HAART group (P < 0.01).
  
  
  CONCLUSIONS
  Highly active antiretroviral therapy can damage liver function in pediatric HIV-infected subjects, especially in those with HBV/HCV co-infection. NVP was more harmful to liver function of pediatric HIV-infected subjects than EFV.
authors.affiliation: Department of Nursing, School of Medicine, Taizhou University, Taizhou 318000, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Wu
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Changzhong
authors.initials: C
authors.lastname: Jin
authors.affiliation: Department of Basic Medicine, School of Medicine, Taizhou University, Taizhou 318000, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Bai
authors.affiliation: Department of Basic Medicine, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Henry
authors.initials: H
authors.lastname: Davies
authors.affiliation: Department of Nursing, School of Medicine, Quzhou College of Technology, Quzhou 324000, China.
authors.forename: Heping
authors.initials: H
authors.lastname: Rao
authors.affiliation: Department of Oncology, School of Medicine, Taizhou University, Taizhou 318000, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liang
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Nanping
authors.initials: N
authors.lastname: Wu
keywords: Co-infection; hepatitis B virus; hepatitis C virus; highly active antiretroviral therapy; human immunodeficiency virus; liver function; pediatric