Gebremicael Gebremedhin, Tola Habteyes Hailu, Gebreegziaxier Atsbeha, Kassa Desta
HIV and TB Diseases Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
HIV AIDS (Auckl). 2021 Mar 25;13:329-336. doi: 10.2147/HIV.S283076. eCollection 2021.
Hepatotoxicity is one of the risk factors associated with treatment non-adherence, which is the main risk factor for drug resistance. Therefore, this study aimed to determine the incidence and risk factors of hepatotoxicity during highly active antiretroviral therapy (HAART) among people living with HIV in Ethiopia.
A prospective cohort study was conducted between April 2007 and January 2011 at Saint Peter Specialized Hospital, Akaki and Kality Health Centers, Addis Ababa, Ethiopia. A total of 316 HIV-infected adult individuals (70 participants were HIV and TB co-infected and 246 were infected with HIV alone) were included in this study. The study participants were followed for a total of 18 months with or without HAART. Socio-demographic data were collected using a structured questionnaire, and venous blood samples were collected for laboratory tests. Logistic regression and Poisson regression were used to determine the independent effect of each variable on hepatotoxicity at baseline and end of follow-up.
Of 316 HIV-infected people, 72 (22.8%) participants had an elevated ALT/AST which was 100% mild-to moderate hepatotoxicity at baseline. Baseline CD4 T-cell count ( = 0.027) and HIV co-infection with TB ( < 0.001) were independently associated with hepatotoxicity at baseline. The overall incidence rate of hepatotoxicity in participants on HAART (21.8 per 100 person-years) was lower than participants who were HAART naïve (33.3 per 100 person-years) ( = 0.009).
High incidence of mild-to-moderate hepatotoxicity and low severe hepatotoxicity were observed in HIV-infected individuals who were on HAART or were HAART naïve. HAART may minimize the occurrence of hepatotoxicity. Although HAART could minimize hepatotoxicity among HIV-infected people, to manage mild and moderate hepatotoxicity liver function test monitoring is required.
肝毒性是与治疗不依从相关的风险因素之一，而治疗不依从是耐药性的主要风险因素。因此，本研究旨在确定埃塞俄比亚艾滋病毒感染者在接受高效抗逆转录病毒治疗（HAART）期间肝毒性的发生率及风险因素。
2007年4月至2011年1月在埃塞俄比亚亚的斯亚贝巴的圣彼得专科医院、阿卡基和卡利蒂健康中心进行了一项前瞻性队列研究。本研究共纳入316名感染艾滋病毒的成年个体（70名参与者同时感染艾滋病毒和结核病，246名仅感染艾滋病毒）。研究参与者接受了为期18个月的随访，无论是否接受HAART。使用结构化问卷收集社会人口学数据，并采集静脉血样进行实验室检测。采用逻辑回归和泊松回归来确定每个变量在基线和随访结束时对肝毒性的独立影响。
在316名感染艾滋病毒的人中，72名（22.8%）参与者的谷丙转氨酶/谷草转氨酶升高，在基线时为100%轻度至中度肝毒性。基线CD4 T细胞计数（=0.027）和艾滋病毒与结核病合并感染（<0.001）与基线时的肝毒性独立相关。接受HAART的参与者肝毒性的总体发病率（每100人年21.8例）低于未接受HAART的参与者（每100人年33.3例）（=0.009）。
在接受HAART或未接受HAART的艾滋病毒感染者中，观察到轻度至中度肝毒性的高发生率和低重度肝毒性。HAART可能会使肝毒性的发生降至最低。尽管HAART可以使艾滋病毒感染者的肝毒性降至最低，但仍需要进行肝功能测试监测以管理轻度和中度肝毒性。
