HEPATOTOXICITY AND ASSOCIATED RISK FACTORS IN HIV-INFECTED PATIENTS RECEIVING ANTIRETROVIRAL THERAPY AT FELEGE HIWOT REFERRAL HOSPITAL, BAHIRDAR, ETHIOPIA

Abstract

BACKGROUND: In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment
(ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was
conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred
as >40IU/L for both males and females).
METHODS: A cross sectional study was conducted on HIV infected individuals who are on ART and
suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012.
Venous bloods were collected from each patient and processed parallely to determine ALT, number of
HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.
RESULTS: Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1-4 levels of
elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8
T cell counts (P=0.011; AOR=1.82; CI: 1.12 - 2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36-
3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15-3.74) independently predicts the
elevation of ALT.
CONCLUSIONS: In HIV infected patients on ART, extreme elevations of ALT were infrequent but
minor elevations were common so that patient-linked variables such as use of alcohol intake must be
taken in to account for better clinical management of ART patients. The role of active HCV co-infection
on the treatment outcome of ART should be further studied.