Abstract:

Background: Hepatotoxicity is common among HIV-infected patients and an increasing cause of mortality and morbidity as effective ART allows persons with HIV to live longer. Studies shoe HIV patients initiating ART develop hepatotoxicity in the first 3 months of ART. Very few studies have looked at hepatotoxicity over longer periods of time when patients continue on ART. Hepatotoxicity is higher in patients with Hepatitis B or C, tuberculosis, and higher CD4 counts. HIV-infected patients living in schistosome-endemic regions may present with co-morbid HIV infection and liver schistosomiasis.

Objectives: To determine prevalence and associated factors of hepatotoxicity among HIV-infected adult using antiretroviral drugs attending Bugando HIV clinic.

Methodology: This was cross-sectional study designed to explore hepatotoxicity in outpatients seeking care at Bugando Medical Centre (BMC)’s Care and Treatment Centre (CTC). Eligible patients were enrolled serially August – December 2014. We enrolled two groups of patients: those on ART for 3-6 months and those on ART for >36 months. Face-to-face interviews was conducted using structured, pre-validated questionnaires. Blood was collected for ALAT, ASAT, bilirubin levels, hepatitis B antigen, and hepatitis C antibody and RBG, urine-CCA (Circulating Cathodic Antigen) test and Bed site abdominal ultrasound was done and confirmed by radiologist/ultrasonographer.

Results: The prevalence of hepatotoxicity among 152 adults on ART for 3-6 months was 19.7% for mild to moderate hepatotoxicity and 4.6% for severe hepatotoxicity. Among the 153 patients who had been on ART>3 years, the prevalence of mild to moderate hepatotoxicity was 12.4% and severe hepatotoxicity was 4.6%. The most strongly-associated factors for hepatotoxicity in patients used 3 – 6 months were use of local herbal medication, alcohol consumption, schistosomiasis infection, hepatomegaly, elevated baseline ALT, positive hepatitis B antigen test, and positive hepatitis C antibody test. In HIV infected adults on ART for > 3 years, associated factors included receiving a previous ART regimen d4T/3TC/NVP or AZT/3TC/EFV and the use of anti TB, fever, dark urine, skin rash, pruritus, lake water contact, history of cultivating rice, liver tenderness, hepatomegaly, and positive hepatitis B surface antigen test, positive hepatitis C antibody test, positive schistosomal antigen test, and hyperechoic liver on abdominal ultrasound.

Conclusion: Hepatotoxicity remains high in HIV infected adults using ART for 3-6 months and those used ART for more than 3 years, affecting approximately 25% of patients at 3-6 months and 15% after 3 years. Most cases of hepatotoxicity were mild to moderate, but nearly 5% of patients in both groups met criteria for severe hepatotoxicity. This is the first study to our knowledge to show association of hepatotoxicity among HIV adults using ART with schistosomiasis infection.