Liver enzyme elevations in a cohort of HIV/ AIDS patients on first-line antiretroviral therapy in Namibia: findings and implications

PA Mataranyika, D Kibuule, F Kalemeera, H Kaura, B Godman, WT Rennie

Research output: Contribution to journalArticle

Abstract

Introduction: All antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced liver injury has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed. Objective: Determine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS. Methods: Retrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART naïve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1 year treatment period. Patterns of ALT changes at baseline, 3 months and 6 months were analyzed using ANOVA and Bonferroni test for pairwise comparisons. Results: Of 79 eligible patients, 72 developed significant ALT elevation within 3 months of ART initiation (F (3, 76) = 6.4, p = 0.002, η2= 0.193). Four 4 (5.6%) and 1 (1.38%) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of < 350 cells/mm3; female gender and age over 40 years were the main factors associated with moderate or severe ALT elevation. Conclusions: First line ART commonly induce mild self-limiting liver enzyme elevation in Namibian HIV patients especially in the first 3 months. Consequently, there is a need to monitor ALT levels for at least 3 months after initiation mainly in high risk patients to reduce side-effect concerns. This is already happening.
LanguageEnglish
JournalAlexandria Journal of Medicine
Publication statusAccepted/In press - 17 Mar 2017

Fingerprint

Namibia
Transferases
Acquired Immunodeficiency Syndrome
Alanine
HIV
Liver
Enzymes
Therapeutics
Africa South of the Sahara
Poisons
Wounds and Injuries
CD4 Lymphocyte Count
Analysis of Variance
Cohort Studies
Referral and Consultation

Keywords

  • liver enzyme elevation
  • ALT
  • antiretroviral therapy
  • HIV/AIDS
  • Namibia

Cite this

@article{0a9ba2f6eb194cf88b22f9ad3bc94aff,
title = "Liver enzyme elevations in a cohort of HIV/ AIDS patients on first-line antiretroviral therapy in Namibia: findings and implications",
abstract = "Introduction: All antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced liver injury has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed. Objective: Determine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS. Methods: Retrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART na{\"i}ve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1 year treatment period. Patterns of ALT changes at baseline, 3 months and 6 months were analyzed using ANOVA and Bonferroni test for pairwise comparisons. Results: Of 79 eligible patients, 72 developed significant ALT elevation within 3 months of ART initiation (F (3, 76) = 6.4, p = 0.002, η2= 0.193). Four 4 (5.6{\%}) and 1 (1.38{\%}) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of < 350 cells/mm3; female gender and age over 40 years were the main factors associated with moderate or severe ALT elevation. Conclusions: First line ART commonly induce mild self-limiting liver enzyme elevation in Namibian HIV patients especially in the first 3 months. Consequently, there is a need to monitor ALT levels for at least 3 months after initiation mainly in high risk patients to reduce side-effect concerns. This is already happening.",
keywords = "liver enzyme elevation, ALT, antiretroviral therapy, HIV/AIDS, Namibia",
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Liver enzyme elevations in a cohort of HIV/ AIDS patients on first-line antiretroviral therapy in Namibia : findings and implications. / Mataranyika, PA; Kibuule, D; Kalemeera, F; Kaura, H; Godman, B; Rennie, WT.

In: Alexandria Journal of Medicine, 17.03.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Liver enzyme elevations in a cohort of HIV/ AIDS patients on first-line antiretroviral therapy in Namibia

T2 - Alexandria Journal of Medicine

AU - Mataranyika, PA

AU - Kibuule, D

AU - Kalemeera, F

AU - Kaura, H

AU - Godman, B

AU - Rennie, WT

PY - 2017/3/17

Y1 - 2017/3/17

N2 - Introduction: All antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced liver injury has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed. Objective: Determine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS. Methods: Retrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART naïve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1 year treatment period. Patterns of ALT changes at baseline, 3 months and 6 months were analyzed using ANOVA and Bonferroni test for pairwise comparisons. Results: Of 79 eligible patients, 72 developed significant ALT elevation within 3 months of ART initiation (F (3, 76) = 6.4, p = 0.002, η2= 0.193). Four 4 (5.6%) and 1 (1.38%) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of < 350 cells/mm3; female gender and age over 40 years were the main factors associated with moderate or severe ALT elevation. Conclusions: First line ART commonly induce mild self-limiting liver enzyme elevation in Namibian HIV patients especially in the first 3 months. Consequently, there is a need to monitor ALT levels for at least 3 months after initiation mainly in high risk patients to reduce side-effect concerns. This is already happening.

AB - Introduction: All antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced liver injury has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed. Objective: Determine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS. Methods: Retrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART naïve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1 year treatment period. Patterns of ALT changes at baseline, 3 months and 6 months were analyzed using ANOVA and Bonferroni test for pairwise comparisons. Results: Of 79 eligible patients, 72 developed significant ALT elevation within 3 months of ART initiation (F (3, 76) = 6.4, p = 0.002, η2= 0.193). Four 4 (5.6%) and 1 (1.38%) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of < 350 cells/mm3; female gender and age over 40 years were the main factors associated with moderate or severe ALT elevation. Conclusions: First line ART commonly induce mild self-limiting liver enzyme elevation in Namibian HIV patients especially in the first 3 months. Consequently, there is a need to monitor ALT levels for at least 3 months after initiation mainly in high risk patients to reduce side-effect concerns. This is already happening.

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