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Prevalence of liver enzyme abnormalities in people infected with hiv 1in indian population

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Answered by arnavaryansingh
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Research Article

Prevalence and Clinical Spectrum of Liver Disease in Nepalese HIV-Sero-Positive Patients Undergoing Antiretroviral Therapy: A Cross-Sectional Hospital Based Study

Roshan Kumar Jha1,2 and Shiv Kumar Sah3

1Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
2National Academy of Medical Science, Bir Hospital, Mahaboudha, Kathmandu, Nepal
3Faculty of Pharmaceutical Science, Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal

Correspondence should be addressed to Shiv Kumar Sah; [email protected]

Received 12 November 2016; Revised 15 February 2017; Accepted 11 May 2017; Published 11 June 2017

Academic Editor: Patrice K. Nicholas

Copyright © 2017 Roshan Kumar Jha and Shiv Kumar Sah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Liver enzyme abnormalities are common in HIV patients, and the prevalence varies across the nations. In Nepal, however, prevalence of liver enzyme disorder and the spectrum of these populations are lacking.Objective. The present study sheds light on prevalence and clinical spectrum of liver disease in Nepalese HIV-sero-positive patients. Methods. This cross-sectional study was conducted at OPD/ART, Clinic of Bir Hospital, NAMS. One hundred and forty-four HIV positive patients were enrolled consecutively and their clinical profiles of liver injury were investigated. Results. Of 144 recruited patients, liver enzyme injury was observed in 82 (56.9%). Majority 61 (42.4%) of these cases had hepatocellular type of liver injury. Opportunistic infections were reported in 18 cases, with 9 (6.2%) TB and 8 (5.6%) HCV. Test for significance of liver injury confirmed the absence of any tendency towards an association with coinfection, CD4 cells, ART regimen, and alcohol consumption (). However, gender significantly linked with liver injury as well as the pattern of liver injury ().Conclusion. The study revealed high rate of liver injury in a substantial proportion of HIV individuals, stressing that a regular clinic follow-up is necessary for the HIV individuals who are undergoing ART.

1. Introduction

Liver enzyme abnormalities are common in HIV patients and have been reported in 20–93% of HIV-infected populations [1, 2]. The common causes encompass opportunistic infections, malignancies, and drug toxicities. Incidence of cirrhosis and mortality attributable to liver disease are considerably increased in HBV and hepatitis C virus infected HIV patients [3–6].

Several antiretroviral drugs from PI, NRTIs, and NNRTIs groups are identified for liver serum enzyme (alanine aminotransferase or aspartate aminotransferase) elevation [7–9]. However, in many circumstances, liver injury patients are underreported because as much as 50% of patients are not manifesting symptoms despite the liver enzyme elevation [10]. After initiating ART, the reported incidence of severe liver toxicity ranges from 2 to 18% [11–13]. Likewise, Protease inhibitor (PI) manifested more antiretroviral therapy related liver injury and the rates of hepatotoxicity from various PI have ranged from 1% to 9.5%, with few patients exhibiting serious liver-related outcome [14]. Besides the antiretroviral drugs, other frequently prescribed drugs for the management of opportunistic infection including antitubercular drugs are also important cause of liver injury in developing country [15, 16]. Additionally, alcohol use with concurrent hepatotoxic drugs is another independent factor for liver toxicity [11]. The pattern of liver disease etiology described in the published literature may differ from our Nepalese setting owing to availability of recent ART and individual host genetics and susceptibility of the drugs and disease. Thus, the present study aims to illustrate the frequency and the factors associated with liver injury, especially focusing on drug-related liver injury among HIV-infected individuals attending ART Clinic at Bir hospital Kathmandu.

2. Methods

2.1. Study Design

This was a cross-sectional, observational study conducted from Oct 2014 to November 2015.


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