Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in India
Deshwal, R.; Arora, S.
Journal of the Association of Physicians of India 67(3): 67-70
2019
ISSN/ISBN: 0004-5772 PMID: 31304710 Document Number: 697799
Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource limited settings. Elevations in ALT are predictive of increased mortality from liver disease and may be influenced by antiretroviral drugs and concomitant hepatitis B infection. A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as> 40 IU/L) on HIV patients on antiretroviral therapy (ART) was conducted. Baseline ALT levels and at two weeks, six weeks, twelve weeks, twenty four weeks and one year were recorded for 320 patients on ART. Hepatitis B surface antigen was also recorded at baseline. Out of the total 320 patients, 249 were males and 71 females. A total of 252 patient records were used as controls who were not on ART. The mean ALT record before initiating ART was 30.6 IU/L. Peak rise in ALT was observed at twenty four weeks of therapy with mean ALT levels of 54.42 IU/L. Total toxicity was almost similar between the two regimes, nevirapine based being 17.62% and efavirenz based being 16.16%.Toxicty grades were lesser in Hepatitis B positive patients as compared with hepatitis B negative patients overall. This study concludes that elevated ALT levels are seen in patients on antiretroviral therapy and persist throughout the course of first year, though maximum levels are seen at around twenty four weeks of therapy. Total hepatotoxicity was found to be 16.89%. Longer follow up of patients is required to assess the effect of ALT elevations on morbidity and mortality of patients and a close monitoring of ALT is required in patients on ART and other hepatotoxic therapies.