Elevated alanine aminotransferase in antiretroviral‐naïve HIV‐infected African patients: magnitude and risk factors

Abstract

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.

Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania

“…While on one hand anaemia exacerbates heart failure, on the other hand heart failure can cause anaemia. We believe that, at least in this study, anaemia has exacerbated heart failure, as the prevalence of anaemia has previously been reported to be high in HIV infected and antiretroviral naïve patients in Tanzania (Nagu et al, 2012). In fact, severe anaemia was the only responsible cause of heart failure in four patients in this study.…”

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

“…(SSA) [1]. Based on 2008 antenatal sero-surveillance data, an estimated 17.8% Namibians aged 15 -49 years were infected with HIV [2].…”

“…According to the Global HIV/AIDS-Namibia statistics (2015), the reduction of HIV related deaths and improvement in the quality of people living with HIV (PLHIV) are the main goals for the treatment, care and support program [4]. The large scale rollout of ART has resulted in a significant decline in HIV-related morbidity and mortality [1] [5].…”

“…Certain factors have been associated with the development of liver toxicity such as hepatitis co-infection, numerous other liver diseases, including alcohol-related injuries, drug-induced hepatotoxicity, metabolic fatty liver, vascular and autoimmune diseases, infectious diseases and hepato-biliary malignancies. These conditions can affect the clinical management and prognosis of HIV infection [1] [5] [8]. The severity of liver toxicity ranges from transient elevations in transaminases to hepatic failure and death [6].…”

A Comparative Prospective Study of the Effects of Arv on Liver Enzymes in Hiv Positive Patients With HCV Co-Infection and HCV Naïve Patients Attending Art Centre of Jnims, Imphal

“…Similar findings were also documented in few studies done in different parts of the world, 12,13,14,15 and contradictory findings were also documented in various studies from different parts of the globe. 4,5,6,7,8,16,17 Among the HCV positive HIV patients at the time of initiation of ART and at 6 months after initiation of ART, approximately 84% of the patients having CD4 count less than 200/cu.mm had improved and crossed CD4 count above 200/cu.mm, which shows a remarkable improvement, these findings were supported by various studies done in different parts of the world. 12,13,14,15 And among the HCV negative HIV positive patients, the improvement in CD4 counts after 6 months of initiation of ART were marked by about 90% of the patients crossing CD4 count above 200/cu.mm from pre-ART CD4 count below 200/cu.mm, similar finding is universal and is the basis for ART.…”