TITLE:
Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia
AUTHORS:
Lovis P. Shanyengana, Munyaradzi Mukesi, Berta E. van der Colf, Sylvester R. Moyo
KEYWORDS:
ARV, Toxicity, ALT, Namibia, Nevirapine, Efavirenz
JOURNAL NAME:
World Journal of AIDS,
Vol.6 No.3,
September
28,
2016
ABSTRACT: Elevated alanine aminotransferase (ALT)
levels in Human Immunodeficiency Virus (HIV) infected people is a major concern
in the world and especially in Africa. It may lead to liver failure and even
death. Certain antiretroviral (ARV) drugs, such as nevirapine and efavirenz,
are known to cause toxicity. Other causes of elevated ALT are viral hepatitis,
the HIV virus itself and other drugs such as anti-tuberculosis drugs and
alcoholism. The study aimed at determining the prevalence of elevated ALT
levels in HIV positive patients on antiretroviral therapy during the period
2013 to 2014. This was a retrospective study which included 267 patient records
from Katutura and Windhoek Central hospitals in Windhoek, Namibia. The
subjects’ ages ranged from 21 to 82 years. The patients enrolled were on the
first line treatment and their ALT levels were recorded at each monitoring
period. ALT levels, viral hepatitis results and the antiretroviral therapy
(ART) regimen were the most important aspects included in the study. Out of 267
patients, 18% had ALT elevation associated with grade 1 to 4 toxicity levels.
The study found that 1.4% of patients developed severe liver toxicity (grade 3
and 4 toxicity). Toxicity occurred throughout the treatment period but was the
highest at six months of treatment. Patients on nevirapine based regimens had
lower toxicity compared to those receiving efavirenz based regimens. Patients
who had HIV and viral hepatitis co-infection had high toxicity although the
study found no severe hepatotoxicity in these patients.