Background Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource limited settings. Elevations in ALT are predictive of increased mortality from liver disease and may influence choice of first line antiretroviral therapy (ART). Methods A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as > 40 IU/L) was conducted. ART naïve, HIV-infected adults with a baseline ALT who were enrolled in any of the 18 HIV care and Treatment clinics in Dar es Salaam, Tanzania November 2004 and December 2009 were included. Median values were calculated and log-binomial regression models were used to examine predictors of elevated ALT. Results During the study period, 41,891 adults had a baseline ALT performed. The prevalence of ALT greater than 40 IU/L, 120 IU/L and 200 IU/L was 13%, 1% and 0.3%, respectively. In multivariate analyses, male sex, CD4+ T lymphocyte count <200 cells/mm3 and higher WHO clinical stages were associated with a significantly higher risk of ALT >40 IU/L (all p <0.01). Hypertryglyceridemia, hyperglycemia and hepatitis B co-infection (HbsAg+) were significantly associated with higher risk of elevated ALT. Pregnancy, anemia, LDL>130 mg/dl and current TB treatment were associated with significantly reduced risk for elevated ALT. Conclusion In this HIV-infected, ART-naïve, Tanzanian population extreme elevations in ALT were infrequent but minor elevations were not uncommon. Antiretrovirals with potentially hepatotoxic side effects should be initiated with caution in males, patients with hepatitis B co-infection, advanced immunosuppression and components of the metabolic syndrome.
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