Transaminase [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] Activity of HIVFemale Patients on Drugs and Female Patients Not on Drugs

Abstract

Elevated serum transaminase (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) levels have been reported in human immunodeficiency virus (HIV)-infected patients on combination antiretroviral therapy (cART). 100 female patients referred to Virology department of the Jos University teaching Hospital (JUTH), were randomly selected by their physicians on the basis of the following criteria: documented HIV infection, no alcohol abuse (≤ 20 g alcohol daily and no history of chronic alcohol consumption), no history of hereditary and autoimmune liver disease, no evidence of hemochromatosis. Patients with any contraindication for liver biopsy were excluded. Data on demographics, drug or alcohol use, and history of liver diseases were obtained at first visit. Subjects were then classified into control (30), HIV-infected; not on drugs (35) HIV-infected; on drugs (35);a month-by-month documentation of the prescribed drug combination for patients who started medication, provided an avenue for calculating each patient's individual cumulative drug exposure. The test for HIV antibodies, HBsAg were carried out on day one (at first visit) serum ALT and serum AST were determined three (3) months after detection (day 90; after HIV antigen confirmatory test). Thirty-five (35) patients started medication at day one and 35 decided not to start medication until after confirmatory test (three months later).The serum ALT levels of the HIV infected patients on drugs (M=43.94, SD=4.30) was significantly higher than the serum ALT levels of the control group (M=29.17, SD=6.17), t (63) = 10.72, p < .0001 at p <.005 confidence level. In a similar trend, the serum ALT levels of the HIV infected patients not on drugs (M=41.17, SD=2.06) was significantly higher than the serum ALT levels of the control group (M=29.17, SD=6.17), t (63) =10.05, p < .0001 at p <.005 confidence level. On comparison, the serum ALT levels of the HIV infected patients on drugs (M=43.94, SD=4.30) was significantly higher than the serum ALT levels of the HIV infected patients not on drugs (M=41.17, SD=2.06), t (68) = 3.44, p < .0001 at p <.005 confidence level. The serum AST levels of the HIV infected patients on drugs (M=44.54, SD=4.85) was significantly higher than the serum AST levels of the control group (M=32.23, SD=5.93), t (63) =9.21, p < .0001 at p <.005 confidence level. In a similar manner, the serum AST levels of the HIV infected patients not on drugs (M=39.91, SD=1.67) was significantly higher than the serum AST levels of the control group (M=32.23, SD=5.93), t (63) =7.33, p < .0001 at p <.005 confidence level. On comparison, the serum AST levels of the HIV infected patients on drugs (M=44.54, SD=4.85) was significantly higher than the serum AST levels of the HIV infected patients not on drugs (M=39.91, SD=1.67), t (68) = 5.34, p < .0001 at p <.005 confidence level.A correlation plot between ALT and AST levels showed a non-significant correlation between these transaminases in the three groups. Control group (r = 0.098, p < 0.05), HIV (+ve), and HBV (-ve) patients on drugs (r = -0.038, p < 0.05), HIV (+ve), and HBV (-ve) patients not on drugs (r = 0.201, p < 0.05).It has been observed from the study that a significant elevation of liver transaminase levels (ALT and AST) is a serious risk factor associated with management of HIV management with drugs.