Liver Function Changes in HIV Patients Taking Highly Active Antiretroviral Therapy (Heart) In Kampala International University Teaching Hospital.

ABSTRACT

Liver function changes in patients taking HAART can present with serious complications. Coinfection with hepatitis viruses increases the risk of liver toxicity while taking antiretroviral therapy. Baseline transaminases should be checked before beginning antiretroviral therapy and all patients should be screened for preexisting liver disease, most notably hepatitis B and C infections. Regular monitoring of transaminases should be done when commencing antiretroviral therapy. Thus, in patients with normal liver function test result, transaminases could be checked monthly after commencing HAART for at least 3 months. In an ideal health facility if stable, this can be broadened to 3 months interval. Patients who present with preexisting liver disease, monitoring should be performed more frequently when initiating therapy. The less hepatotoxic drugs such as lamivudine and abacavir should be preferred in patients at high risk of hypersensitivity. Risks include coinfection with HBV and HCV infections, a previous record of hepatoxicity, cirrhosis, obesity, and female gender. Minor enzyme elevations (< 5-fold upper limit of normal) are generally safe to tolerate and usually resolve. Patients should be observed closely with regular liver function tests done and a hypersensitivity type drug reaction should be excluded. The onset of clinical symptoms, elevated serum lactate or evidence of severe hepatic dysfunction are suggestive of severe toxicity and HAART should be stopped. Treatment of suspected HAART related hepatoxicity should first involve withdrawal of therapy. Hypersensitivity reactions may be treated with corticosteroids and nucleoside induced mitochondrial damage may improve with riboflavin or thiamine therapy.HIV infected patients have continued to benefit from different drug regimen including HAART. However HAART has been observed to have side effects which include HAART associated hepatotoxicity leading to severe liver impairment among others. A cross-sectional, retrospective study that aimed at assessing liver function changes in HIV/AIDS patients on HAART at KIUTH was done. A total of 40 HIV/AIDS adult patient files with no confounding ailments and who had been on HAART drugs for at least 3 months was evaluated in this study. 51% (n=40) were males, and 49% (n=40) were females. Information was obtained on baseline test results for serum liver enzyme levels and prescribed HAARTs. Only those files with normal baseline test results were evaluated.