Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy

  • Eva Jacomina Jemima Sapulete Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
  • I Gusti Ngurah Sanjaya Putra Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
  • Ketut Dewi Kumara Wati Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali https://orcid.org/0000-0002-6572-3694
  • Hendra Santoso Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
  • I Putu Gede Karyana Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
  • Komang Ayu Witarini Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
  • Ni Nyoman Metriani Nesa Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
Keywords: liver function, pediatric, human immunodeficiency virus, antiretroviral

Abstract

Background Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI).

Objective To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART.

Methods This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records.

Results Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI.

Conclusion Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART.

References

1. Mata-Marin JA, Gaytan-Martinez J, Grados-Chavarria BH, Fuentus-Allen JL, Arroyo-Anduiza CI, Alfaro-Meija A. Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naïve patients: a concordance cross-sectional study. Virol J. 2009;6:181.
2. Siberry GK, Cohen RA, Harris DR, Cruz ML, Oliveira R, Peixoto MF, et al. Prevalence and predictors of elevated aspartate aminotransferase-to-platelet ratio index in Latin American perinatally HIV-infected children. Pediatr Infect Dis J. 2014;33:177-82.
3. Aurpibul L, Bunupuradah T, Sophan S, Boettiger D, Wati DK, Nguyen LV, et al. Prevalence and incidence of liver dysfunction and assessment of biomarkers of liver disease in HIV-infected Asian children. Pediatr Infect Dis J. 2015;34:153-8.
4. Ezhilarasan D, Srilekha M, Raghu R. HAART and Hepatotoxicity. J App. Pharm. Sci. 2017;7:220-6.
5. Kementrian Kesehatan Republik Indonesia. Pedoman Penerapan Terapi HIV pada Anak. In: Kurniati N, editor. Diagnosis infeksi HIV pada anak dan rekomendasi ARV. Jakarta: Kementrian Kesehatan Republik Indonesia; 2014. p. 1-6, 15-7.
6. Ajulo MO, Omole MK, Moody JO, Dixon-Umo TO, Salami OL. Impact of highly active antiretroviral therapy on liver function of under-five HIV-positive children in Southern Nigeria. West Afr J Pharm. 2016;27:33-41.
7. Shiferaw MB, Tulu KT, Zeyege AM, Wubante AA. Liver enzymes abnormalities among highly active antiretroviral therapy experienced and HAART naïve HIV-1 infected patients at Debre Tabor Hospital, North West Ethiopia: a comparative cross-sectional study. AIDS Res Treat. 2016;2016:1-7.
8. Gil AC, Lorenzetti R, Mendes GB, Morcillo AM, Toro AA, Silva MT, et al. Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy. Sao Paulo Med J. 2007;125:205-9.
9. Regulatory Compliance Centre (RCC). Therapeutic research program. Division of AIDS (DAIDS). Table for grading the severity of adult and pediatric adverse events. [cited 2017 June 18]. Available from: http://rsc.tech-res.com/docs/default-source/safety/daids_ae_grading_table_v2_noo2014.pdf>sfvrsn=8.
10. Crane M, Iser D, Lewin SR. Human immunodeficiency virus infection and the liver. World J Hepatol. 2012;4:91-8.
11. Ocama P, Casteinuovo B, Kamya MR, Kirk GD, Reynolds SJ, Kiragga A, et al. Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda. Int J STD AIDS. 2010;21:553-7.
12. Weidle PJ, Moore D, Mermin J, Buchacz K, Were W, Downing R, et al. Liver enzymes improve over twenty-four months of first-line non-nucleoside reverse transcriptase inhibitor-based therapy in rural Uganda. AIDS Patient Care STDS. 2008;22:787-95.
13. Pryce C, Pierre RB, Steel-Duncan J, Evans-Gilbert T, Palmer P, Moore J, et al. Safety of antiretroviral drug therapy in Jamaican children with HIV/AIDS. West Indian Med J. 2008;57:283-45.
14. Kovari H, Ledergerber B, Battegay M, Rauch A, Hirschel B, Foguena AK, et al. Incidence and risk factors for chronic elevation of alanine aminotransferase levels in HIV-infected persons without hepatitis b or c virus co-infection. Clin Infect Dis. 2010;50:502-11.
15. Siberry GK, Patel K, Pinto JA, Puga A, Mirza A, Miller TL, et al. Elevated aspartate aminotransferase-to-platelet ratio index in perintally HIV-infected children in the United States. Pediatr Infect Dis J. 2014;33:855-7.
16. Naidoo S, Evans D, Jong E, Mellet K, Berhanu R. Outcomes of TB/HIV co-infected patients presenting with antituberculosis drug-induced liver injury. S Afr Med J. 2015;105:393-6.
17. Akura B, Oswari H, Supriyatno B, Advani N. Incidence and characteristics of antituberculosis drug-induced hepatotoxicity in children: a preliminary study. Paediatr Indones. 2009;49:342-8.
18. Hassan Ali A, Belachew T, Yami A, Ayen WY. Anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia: nested case-control study. PLoS One. 2013;8:e64622.
19. Pukenyte E, Lescure FX, Rey D, Rabaud C, Hoen B, Chavanet P, et al. Incidence of and risk factors for severe liver toxicity in HIV-infected patients on anti-tuberculosis treatment. Int J Tuberc Lung Dis. 2007;11:78-84.
20. Wakeham K, Parkes-Ratanshi R, Watson V, Ggayi AB, Khoo S, Lalloo DG. Co-administration of fluconazole increases nevirapine concentrations in HIV-infected Ugandans. J Antimicrob Chemother. 2010;65:316–9.
21. Manosuthi W, Chumpathat N, Chaovavanich A, Sungkanuparph S. Safety and tolerability of nevirapine-based antiretroviral therapy in HIV-infected patients receiving fluconazole for cryptococcal prophylaxis: a retrospective cohort study. BMC Infect Dis. 2005;5:67.
22. Martin MV. The use of fluconazole and itraconazole in the treatment of Candida albicans infections: a review. J Antimicrob Chemother. 1999;44:429-37.
23. Manosuthi W, Athichathanabadi C, Uttayamakuli S, Phoorisri T, Sungkanuparph S. Plasma nevirapine levels, adverse events and efficacy of antiretroviral therapy among HIV-infected patients concurrently receiving nevirapine-based antiretroviral therapy and fluconazole. BMC Infect Dis. 2007;7:14.
Published
2018-07-27
How to Cite
1.
Sapulete E, Sanjaya Putra IGN, Kumara Wati K, Santoso H, Karyana IPG, Witarini KA, Metriani Nesa NN. Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy. PI [Internet]. 27Jul.2018 [cited 3Dec.2024];58(4):159-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1798
Section
Articles
Received 2018-02-27
Accepted 2018-06-28
Published 2018-07-27