dc.description.abstract | Background:
Human immunodeficiency infected patients frequently present with elevated level
s of
serum transaminases.
This is
often been attributed to hepatic effects of antiretroviral
drugs.
The
introduction of
life prolonging
anti
-
retroviral therapy
has drastically reduced
the
morbidity and mortality
associated with HIV
.
Because of im
proved
life expectancy,
non
-
HIV/AIDS
defining diseases and drug related toxicities have emerged
as
key issues
in the management and care of people living with HIV
/AIDS
.
Nevirapine is
associated with asymptom
atic elevations of alanine transaminase
(ALT
)
levels
,
and
at times life threatening, clinical liver hepatotoxicity
.
Hepatotoxicity can be
fatal when not recognized early an
d when treatment
not interrupted in time.
Objective
:
This study
aimed
to determine the pattern and risk
factors
for alanine
transamina
se
elevation
among HIV
positive
adult patients on
nevirapine
containing
anti
-
retroviral
regimen
s
at Kenyatta National Hospital.
Methodology
:
We obtained e
thical approval to c
arry out this study
from the KNH
-
Uo
N research and
ethics committee
.
We conduct
ed a retrospective cohort study of HIV positive patients on
nevirapine containing regimens who attended the KNH Comprehensive Care Clinic
between May and August 2014.
We performed generalized linear
regression
to establish
patterns and predictors for ALT
elevation. D
ata obtained from the patient interviews and
abstraction of patient files
, were
analyzed
using STATA version 10.
R
esults
:
Two hundred and forty one
patients took part in the study
.
One hundred and sixty two
(67.2%) had normal
ALT levels t
hroughout the study,
s
eventy
-
two
(29.9%) had mild elevation and seven (2.9%) developed moderate hepatotoxicity.
None of the participants
developed severe or very severe hepatotoxicity
.
In patients with normal ALT at baseline, the
pattern
of ALT change
was
cyclical with
peaks and troughs.
The peak levels seemed to increase with time.
Very sharp peaks were
noted from the 5
th
year
of therapy
onward.
Among
patients who had elevated ALT levels
at baseline the trend was a gradual decline in ALT levels until a
bout 6 years of therapy,
thereafter the AL
T levels started rising progressively
.
Risk factors for ALT elevation differed across sex. P
redictor variables
that were
significantly associated with
ALT elevation i
n both
sexes included;
elevated baseline
ALT le
vel
[
β
=10.14
(95%
CI 7.34
-
12.96); P<0.001]
, [
β
=13.52(95%
CI
9.36
–
17.68); P <
0.001]
and ren
al disease
[
β
=5.44
(95%
CI
2.62
–
8.25); P <0.001],
[
β
=11.52
(95%
CI 3.46
–
19.60); P = 0.005]
in females and males respectively.
Ethnicity had a protective effect
in both
sexes;
[
β
-
6.61(95%CI
-
9.28,
-
3.93);
P< 0.001]
in males
and
[
β
-
1.20(95% CI
-
2.39,
-
0.01); P= 0.048
]
in females
.
Among the different ethnic groups
,
Nilotes and Cushites
had lower ALT levels compared to Bantus.
Other factors that were significant included; sm
oking (P=0.001), concurrent illnesses
(P=0.045), previous adverse drug reactions (P=0.040) in females and a longer duration of
anti
-
retroviral therapy [
β
1.81(95%CI 0.89
–
2.73); P < 0.001] in males. Poor adherence
had a protective effect [
β
-
1.62(95%CI
-
3.20,
-
0.04); P=0.045] among females, whereas
initiation on AZT+3TC+NVP had a significant protective effect [
β
-
7.80
(95%CI
-
13.96,
-
1.63);
P=
0.013
] in males.
Conclusion
Alanine
transaminase
elevation might occur in up to
one third
of HIV
/AIDS
positive
ad
u
lt patients taking nevirapine based ART
.
N
one of the patients developed severe or
very severe hepatotoxicity
in this cohort xiv
In
setting
where transaminase testing is available, monitoring
should focus on delayed
hepatotoxicity, patients with abnormal bas
eline ALT and those with impaired renal
functioning.
All HIV
-
infected patients should be screened for liver disease at the time entry into care | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |