Anti-retroviral therapy and serum protein levels in HIV-1 seropositive patients: a five-year retrospective study (original) (raw)
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Journal of Aids and Hiv Research, 2013
Alanine aminotransferase (ALT) is a hepatic enzyme that could be used as markers of hepatocellular injury. Liver enzyme elevations are frequent in human immune deficiency virus (HIV)-infected patients which may be caused by the HIV virus in those without other risk factors for liver damage. This study was designed to evaluate the correlation between HIV viral load and serum levels of ALT, a marker of hepatic damage. This was a cross-sectional analytic study performed among HIV infected naive patients without other risk factor for liver disease. The results of the study shows that of the 166 participants recruited into this study, 104 (62.7%) were females. The participants' mean CD4 count was 180.04 ± 38.08 (95% confidence interval (CI), 164.11 to 195.96). The mean viral load log 10 (copies/ml) was 5.18 ± 4.28, and ALT (UI/L) was 24.80 ± 1.29 (95% CI, 22.26 to 27.35). Sixty (36.2%) of the studied participants had high viral load ≥ 100,000 copies/ml, while 22 (13.3%) had high ALT (≥ 40 IU/L). A positive correlation (Pearson correlation coefficient, r = 0.274, P = 0.000) between HIV viral load and ALT was observed. After adjusting for age, sex and CD4 count in a multivariable linear regression model, the correlation between HIV viral load and ALT remained significant (p = 0.003). The finding of positive correlation between HIV viral load and ALT levels in HIV infected naive patients suggests a linear relation between ALT level and HIV-1 viral load in HIV patients without other risk factor for liver damage. We recommend evaluating patients with high ALT for early anti-retroviral therapy (ART) in those without risk factor for liver damage regardless of the CD4+ cell count, especially where facility for estimating viral load is not available.
European Journal of Medical Research, 2009
Background and Aims: Quantitative tests of liver function (QTLF) which are based on the hepatic metabolism or clearance of test substances have been successfully used to predict prognosis of a variety of different liver diseases. Still sufficient data in HIV-patients under anti-retroviral therapy (ART) are lacking. Therefore, the aim of this prospective study was to investigate if and to what extent ART influences a broad panel of quantitative tests of liver function in patients with HIV-infection. Patients and Methods: Nineteen patients (14 males, 5 females, mean age 40 years) with HIV-infection underwent QTLF including lidocaine half-life test (LHT), galactose elimination capacity (GEC), and indocyanine green clearance (IGC). These tests were performed before and 3 to 6 months after initiation of anti-retroviral therapy. Twenty age-matched healthy, medicationand virus-free adults served as controls. Results: Lidocaine half-life was significantly lower in HIV-patients without ART. Combining anti-retroviral therapies shifted cytochrome p450 activity back into standard ranges. Galactose elimination capacity as a parameter of cytosolic liver function and indocyanine green clearance as a parameter of liver perfusion were not affected by ART. Conclusions: QTLF may be a tool to predict prognosis or hepatic complications in HIV-infected patients with liver disease. Early determination of lidocaine half-life seems to be useful-this should be considered during the treatment of HIV-positive individuals.
Background: Liver disease is a common feature in patients with Human Immunodeficiency Virus (HIV) infection and hence it is important to consider its involvement when treating HIV infected patients. In this study we analysed the liver functions by estimating the liver enzymes [Alanine amino transferases (ALT), Aspartate amino transferases (AST)] and bilirubin levels [total/unconjugated] at the time of diagnosis of HIV positive patients and compared it with healthy controls. This study aimed to determine the baseline values of liver enzymes and total and unconjugated bilirubin before the start of antiretroviral therapy. Methods: Liver enzymes [ALT and AST] and Bilirubin [total and unconjugated bilirubin] were analysed in a total of 200 patients and compared with equal number of age and sex matched healthy controls. Results: The mean age of healthy controls were 37.17±9.12 years and the mean age of the HIV positive cases were 43.14±11.09 years In recently positive HIV patients the increase in liver enzymes [ALT and AST] and Bilirubin [total, unconjugated] was statistically significant (P <0.001) when compared to the healthy controls Conclusion: The involvement of liver as reflected by increase in enzymes and bilirubin at the time of diagnosis is significant as there is a time lag between the onset of infection to that of diagnosis. Therefore the baseline liver function tests at the time of diagnosis, before the start of antiretroviral therapy acts as a prognostic indicator and is useful in subsequent monitoring of the patient.
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.7\_July2017/IJHSR\_Abstract.09.html, 2017
Some biological changes are observed during human immuno deficiency virus (HIV) infection. Once cluster of differentiation 4 (CD4 +) count decreased to 500 cells/mm 3 (highly active antiretroviral therapy) (HAART) is initiated. This work tried to elucidate the effect of HAART on some of the biochemical changes caused by HIV infection. 63 subjects comprising, 20 apparently healthy control subjects and 43 HIV positive subjects ready to be placed on HAART (these subjects attended HIV clinic in Bishop Shanahan Hospital Nsukka) were recruited for the study. A known volume of blood, 10ml was collected from each subject through venepuncture prior to the initiation of HAART (basal sample) then 4 and 8 months into the administration of HAART. The activities and concentrations of the following biochemical parameters: Aspartate amino transferase (AST), Alanine, amino transferase (ALT), total protein and albumin, were determined. CD4 + count was also determined at each presentation. The results showed that CD4 + count increased significantly from baseline to 8 months into treatment (p < 0.05), ALT and AST increased from baseline to 4 months into treatment, but decreased by the 8th month, (ALT: p < 0.05) (AST: p > 0.05). Total protein and albumin increased significantly from baseline to 8 months into treatment (p < 0.05). Even though the studied parameters improved because of treatment they were still significantly different from the observations made for the healthy control subjects (p < 0.05). Hence treatment with HAART amounted to a positive prognosis for HIV/AIDS infection as it concerns liver enzymes and plasma protein and albumin.
Virology Journal, 2009
Abnormalities in liver function tests could be produced exclusively by direct inflammation in hepatocytes, caused by the human immunodeficiency virus (HIV). Mechanisms by which HIV causes hepatic damage are still unknown. Our aim was to determine the correlation between HIV viral load, and serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as markers of hepatic damage in HIV naive infected patients. We performed a concordance cross-sectional study. Patients with antiviral treatment experience, hepatotoxic drugs use or co-infection were excluded. We used a Pearson's correlation coefficient to calculate the correlation between aminotransferases serum levels with HIV viral load. We enrolled 59 patients, 50 men and 9 women seen from 2006 to 2008. The mean (± SD) age of our subjects was 34.24 ± 9.5, AST 37.73 ± 29.94 IU/mL, ALT 43.34 ± 42.41 IU/mL, HIV viral load 199,243 ± 292,905 copies/mL, and CD4+ cells count 361 ± 289 cells/mm3. There was a moderately strong, positive correlation between AST serum levels and HIV viral load (r = 0.439, P < 0.001); and a weak correlation between ALT serum levels and HIV viral load (r = 0.276, P = 0.034); after adjusting the confounders in lineal regression model the correlation remained significant. Our results suggest that there is an association between HIV viral load and aminotransferases as markers of hepatic damage; we should improved recognition, diagnosis and potential therapy of hepatic damage in HIV infected patients.
Liver function tests of HIV/AIDS patients at the Nylon District Hospital, Douala, Cameroon
Background: Antiretroviral therapy (ART) which substantially reduces morbidity and mortality in human immunodeficiency virus (HIV) seropositive patients has been associated with hepatotoxicity. This study was aimed at investigating the effects of HIV infection and ART on liver function amongst HIV seropositive patients in Douala, Cameroon. Methods: A cross- sectional study was conducted from March to August, 2012 at the Nylon District Hospital, Douala. Demographic data were collected using a structured questionnaire. Serum alanine and aspartate aminotransferases (ALT and AST), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) activities were determined using colorimetric techniques. Results: The mean age of the study participants was 37.9 ± 6.02 years. A majority of the study participants (68.0%) were females. The mean CD4+ T lymphocyte cell count of HIV/AIDS patients on ART was significantly higher than the ART- naïve patients (p<0.05). The mean serum AST and ALT activities of ART-naïve patients were significantly higher than the control subjects (p<0.05). Similarly, the mean serum transaminases and GGT activities of HIV/AIDS patients on ART were significantly higher than the control subjects (p<0.05). The mean serum ALP and GGT activities of HIV/AIDS patients receiving ART were significantly higher than the ART- naïve patients (p<0.05). Conclusions: The present study provides evidence to suggest that both infection with HIV and treatment with ART are associated with liver injury.
PLOS ONE, 2015
Background Diagnosing hepatic injury in HIV infection can be a herculean task for clinicians as several factors may be involved. In this study, we sought to determine the effects of antiretroviral therapy (ART) and disease progression on hepatic enzymes in HIV patients. Methods A case-control study conducted from January to May 2014 at the Akwatia Government Hospital, Eastern region, Ghana, The study included 209 HIV patients on ART (designated HIV-ART) and 132 ART-naive HIV patients (designated HIV-Controls). Data gathered included demography, clinical history and results of blood tests for hepatic enzymes. We employed the Fisher's, Chi-square, unpaired t-test and Pearson's correlation in analysis, using Graph-Pad Prism and SPSS. A P value < 0.05 was considered significant. Results Median CD4 lymphocyte count of HIV-ART participants (604.00 cells/mm 3) was higher than that of HIV-Controls (491.50 cells/mm3; P = 0.0005). Mean values of ALP, ALT, AST and GGT did not differ between the two groups compared (P > 0.05). There was a significant positive correlation between hepatic enzymes (ALP, ALT, AST and GGT) for both groups (p < 0.01 each). Duration of ART correlated positively with ALT (p < 0.05). The effect size of disease progression on hepatic enzymes for both groups was small. Conclusion Antiretroviral therapy amongst this population has minimal effects on hepatic enzymes and does not suggest modifications in therapy. Hepatic injury may occur in HIV, even in the PLOS ONE |
International STD Research & Reviews, 2018
Background: Increasing access to highly active antiretroviral therapy (HAART) in our population in recent times has necessitated the assessment of the impact of these therapies on hepatic enzymes. We therefore aimed to assess the impact of highly active antiretroviral therapy on hepatic enzymes and to ascertain the trend of hepatic enzyme elevation in HIV disease progression. Method: 192 confirmed HIV individuals consisting of 104 HAART experienced and 88 HAART naïve patients were recruited into the study. Venous blood was taken for the assay of Alkaline Phosphatase (ALP), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Gammaglutamyltransferase (GGT). Results: There was a significant increase (p<0.0.5) in the median AST, GGT, ALT and ALP in the HAART naïve patients than the HAART experienced patients. There was a significant increase (p<0.0001) in the prevalence of AST, ALT, ALP and GGT elevation in the HAART naïve patients (35.2%, 28.4%, 28.4% and 48.9% respectively) than the HAART experienced patients (5.8%,
Alexandria Journal of Medicine
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, η 2 = 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/mm 3 ; 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. KEY WORDS: Liver enzyme elevation; ALT; antiretroviral therapy; HIV/AIDS; Namibia Highlights All antiretroviral therapies (ARTs) are potentially toxic to the liver. This is particularly important in sub-Saharan Africa where the rising incidence of ART induced liver injury, where the majority of the world's HV/ AIDS patients current reside, has complicated HIV treatment leading to recent revisions of guidelines Despite these concerns, there have been limited studies evaluating ART induced liver injury in these countries, especially Namibia with its high HIV burden. This need to be addressed to guide future clinical practice especially with a high female population with HIV in Africa who may have different responses to treatment to male HIV patients typically seen in Western countries The majority of patients in this study had developed significant ALT elevation within 3 months of ART initiation. There was no significant difference between mean ALT levels at baseline and month 6 Based on our findings, patients with high risk of hepatocellular damage such as low baseline CD4 count , of female sex, and > grade 2 ALT elevations, and patients who test positive for HBV/HCV, should be monitored for at least 6 months after initiation of NVP and EFV based ART. This is already happening in Namibia