Ocama P, Castelnuovo B, Kamya M R, Kirk G D, Reynolds S J, Kiragga A, Colebunders R, Thomas D L
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
Int J STD AIDS. 2010 Aug;21(8):553-7. doi: 10.1258/ijsa.2010.010027.
Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting.
通过前瞻性评估坎帕拉一组患者36个月内的天冬氨酸转氨酶（AST）数据，确定接受抗逆转录病毒治疗（ART）患者的肝酶升高情况。部分患者测定了乙肝病毒（HBV）状态。根据艾滋病临床试验组标准，将肝毒性分为I至IV级。546例患者中，377例（69%）为女性；总体基线CD4 + T细胞中位数为97/μL（四分位间距[IQR] 20 - 164）。470例患者中有42例（9%）检测到乙肝表面抗原（HBsAg）。ART方案包括拉米夫定，联合奈韦拉平和司他夫定（d4T）（74%）或依非韦伦和齐多夫定（AZT）（26%）。基线时AST水平中位数（IQR）为35（27，53 IU/L）。在36个月期间，仅8例患者出现III级AST升高。HBsAg和ART方案均未影响AST水平。男性性别及CD4 + 相对于基线的变化与AST升高相关。HIV/HBV合并感染患者AST升高风险未增加，这种情况在该研究中不常见。
