Abnormalities in Liver Function Tests in HIV Positive Children on Highly Anti-retroviral Therapy in a Tertiary Hospital in Abuja, Nigeria

Abstract

Background: Liver related deaths are becoming common amongst HIV-infected individual with longer survival on antiretroviral therapy. This study was undertaken to document derangement in liver function tests with associated risk factors in HIV infected children and adolescents on highly active antiretroviral therapy overtime in our health facility, for guide for intervention, and baseline information.  Methods: A cross sectional hospital based study was conducted among HIV-infected children and adolescents aged 6 months-18 years on antiretroviral therapy in our health institution from February to May 2016 for the above objectives. Results: Of the total of 161 patients studied with a mean age of 10.13±4.5 years, 103(64.0%) were males, and 137 (85.1%) on 1st line HAART. Hepatotoxicity was seen in 37(22.9%) of patients, with grade 3 and 4 toxicity (alanine aminotransaminase of 5.0 - >10.0 x ULN) being recorded in 3.4% of those on antiretroviral therapy for <10 years and 13.3% of those >10 years. Grade 3 and 4 hepatotoxicity was also found to be commoner in patients on zidovudine + lamivudine + nevirapine (5.7%), zidovudine + lamivudine + lopinavir-ritonavir (18.2%), and tenofovir + emtricitabine + lopinavir-ritonavir (100%). Risk factors for hepatotoxicity were 2nd line medication [OR of 0.26 (CI 0.81-0.97), p value = 0.013, and co-administration with trimethoprim/sulfamethoxazole [OR 0.18, (CI 0.55-9.59), p value =0.026)]. Conclusion:  HAART was well tolerated by most children and adolescents in this study, however, those on 2nd line medication and co-administration with trimethoprim/sulfamethoxazole need more regular monitoring for hepatotoxicity.