Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

Sabina F. Mugusi; David Sando; Ferdinand M. Mugusi; Claudia Hawkins; Said Aboud; Wafaie W. Fawzi; Christopher R. Sudfeld

doi:10.1177/2325958219884939

Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

Sabina F. Mugusi^*, David Sando, Ferdinand M. Mugusi, Claudia Hawkins, Said Aboud, Wafaie W. Fawzi, Christopher R. Sudfeld

^*Corresponding author for this work

Medicine, Infectious Diseases Division

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL (P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L (P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.

Original language	English (US)
Journal	Journal of the International Association of Providers of AIDS Care
Volume	18
DOIs	https://doi.org/10.1177/2325958219884939
State	Published - 2019

Funding

Written informed consent was obtained from all participants included in the study. The study protocol was approved by the institutional review boards of the Harvard School of Public Health (IRB12981), Muhimbili University of Health and Allied Sciences (MU/DRP/AEC/Vol.XVI/164), Tanzania Food and Drugs Authority (CD/TFDA.226/6), and the National Health Research Ethics Sub-Committee (NIMR/HQ/R.8a/Vol. IX/432). The authors are grateful to all the study participants. The authors also thank all the clinicians and nurses from the 7 different clinical sites in Dar es Salaam. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This clinical trial was supported by grant R01 HD32257 from the National Institute of Child Health and Development. Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under award number D43 TW009775. ORCID iD Sabina F. Mugusi https://orcid.org/0000-0003-3367-0564

Keywords

ALT
HIV
antiretroviral
hepatitis
hepatotoxicity
liver

ASJC Scopus subject areas

Infectious Diseases
Dermatology
Immunology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{b9d2e755556f45cbaf9d05ed20b8ceea,

title = "Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy",

abstract = "Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL (P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L (P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.",

keywords = "ALT, HIV, antiretroviral, hepatitis, hepatotoxicity, liver",

author = "Mugusi, {Sabina F.} and David Sando and Mugusi, {Ferdinand M.} and Claudia Hawkins and Said Aboud and Fawzi, {Wafaie W.} and Sudfeld, {Christopher R.}",

note = "Funding Information: Written informed consent was obtained from all participants included in the study. The study protocol was approved by the institutional review boards of the Harvard School of Public Health (IRB12981), Muhimbili University of Health and Allied Sciences (MU/DRP/AEC/Vol.XVI/164), Tanzania Food and Drugs Authority (CD/TFDA.226/6), and the National Health Research Ethics Sub-Committee (NIMR/HQ/R.8a/Vol. IX/432). Funding Information: The authors are grateful to all the study participants. The authors also thank all the clinicians and nurses from the 7 different clinical sites in Dar es Salaam. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This clinical trial was supported by grant R01 HD32257 from the National Institute of Child Health and Development. Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under award number D43 TW009775. ORCID iD Sabina F. Mugusi https://orcid.org/0000-0003-3367-0564 Publisher Copyright: {\textcopyright} The Author(s) 2019.",

year = "2019",

doi = "10.1177/2325958219884939",

language = "English (US)",

volume = "18",

journal = "Journal of the International Association of Providers of AIDS Care",

issn = "2325-9574",

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TY - JOUR

T1 - Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

AU - Mugusi, Sabina F.

AU - Sando, David

AU - Mugusi, Ferdinand M.

AU - Hawkins, Claudia

AU - Aboud, Said

AU - Fawzi, Wafaie W.

AU - Sudfeld, Christopher R.

N1 - Funding Information: Written informed consent was obtained from all participants included in the study. The study protocol was approved by the institutional review boards of the Harvard School of Public Health (IRB12981), Muhimbili University of Health and Allied Sciences (MU/DRP/AEC/Vol.XVI/164), Tanzania Food and Drugs Authority (CD/TFDA.226/6), and the National Health Research Ethics Sub-Committee (NIMR/HQ/R.8a/Vol. IX/432). Funding Information: The authors are grateful to all the study participants. The authors also thank all the clinicians and nurses from the 7 different clinical sites in Dar es Salaam. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This clinical trial was supported by grant R01 HD32257 from the National Institute of Child Health and Development. Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under award number D43 TW009775. ORCID iD Sabina F. Mugusi https://orcid.org/0000-0003-3367-0564 Publisher Copyright: © The Author(s) 2019.

PY - 2019

Y1 - 2019

N2 - Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL (P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L (P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.

AB - Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL (P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L (P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.

KW - ALT

KW - HIV

KW - antiretroviral

KW - hepatitis

KW - hepatotoxicity

KW - liver

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U2 - 10.1177/2325958219884939

DO - 10.1177/2325958219884939

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C2 - 31665968

AN - SCOPUS:85074358768

SN - 2325-9574

VL - 18

JO - Journal of the International Association of Providers of AIDS Care

JF - Journal of the International Association of Providers of AIDS Care

ER -

Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

Abstract

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Keywords

ASJC Scopus subject areas

UN SDGs

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