Hepatotoxicity among HIV-Infected Patients Receiving the Highly active Anti-retroviral Therapy: Impact of the Duration of the Therapy and Comorbid Diseases.
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Date
2010-08
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Addis Abeba University
Abstract
The rapid death and morbidity due to opportunistic infections in Human immunodeficiency virus (HIV) patients has been reduced by the introduction of Highly Active Retroviral therapy (HAART). However, hepatotoxicity is now evident as a limiting factor of the benefit of the treatment. The over all incidence is estimated to be 3- 18% and it is up to 30% in patients on HAART. The objective of the study was to assess the liver function of HIV-infected patients receiving HAART so that clinicians will be more careful in prescribing the medications for their patients. In this retrospective cross-sectional study, 750 HIV infected patients who have already started HAART participated. 521 and 229 patients were taking NVP and EFV based regimen, respectively. Chi square and Mann-Whitney test were used to compare base line characteristics between the two groups, which showed no significant difference. Assessment of hepatotoxicity of the different HAART regimens, after initiation of therapy showed no hepatotoxicity with time, as can be seen from median values of the four LFTs (ALT, AST, ALP and TB). The proportion of patients in different hepatototoxcity grades were also analyzed for both NVP and EFV groups. The results showed that severe hepatotoxicity was more common in NVP users groups than EFV groups. While with time, both groups showed high proportion of hepatotoxicity grades before treatment which generally decreases after the initiation of therapy. With in three months of initiation therapy, more severe cases of hepatotoxicity were found when compared with other durations of therapy. Risk factor determination by multivariant logistic regression revealed that sex and age were not factors for hepatotoxicty while corrilation results by spearman rank correlation coefficient of LFTs with each other showed only correlation of TB with the other LFTs was not significant. The suggestion made from these findings is that, hepatotoxicity is more common in NVP users than EFV users and both the drugs are associated with elevation of LFTs just after the start of HAART thus frequent monitoring of liver enzymes after initiation antiretroviral therapy is recommended. However, because of NVP and EFV-associated severe hepatotoxicity cases were observed after the first 12 weeks of therapy, these data indicate that such assessments should continue throughout the treatment period.
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Hepatotoxicity,HIV, patients,therapy ,comorbid diseases