|Year : 2020 | Volume
| Issue : 1 | Page : 40-43
Liver function parameters of patients on antiretroviral therapy attending al-noury specialist hospital Kano, Nigeria
Abdulhadi Sale Kumurya1, Sadiya Ashiru Auta2
1 Department of Medical Laboratory Science, Faculty of Allied Health Science, Bayero University, Kano, Nigeria
2 Department of Biochemistry, Faculty of Basic Medical Science, Bayero University, Kano, Nigeria
|Date of Submission||14-Sep-2019|
|Date of Acceptance||10-May-2019|
|Date of Web Publication||31-Jul-2020|
Prof. Abdulhadi Sale Kumurya
Department of Medical Laboratory Science, Faculty of Allied Health Science, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Context: The hallmark of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) infection is the depletion of CD4hearing cells, especially the T helper cells, resulting in impairment of cellular immune response. The introduction of antiretroviral (ARV) therapy which has changed HIV/AIDS infection into a clinically wieldy disease is a progression development. Aims: The aim of the study was to evaluate the liver function parameters of patients ARV therapy attending Al-Noury Specialist Hospital Kano, Nigeria. Settings and Design: The study is a cross-sectional prospective study. Subjects and Methods: This work evaluated the effect of fixed dose combination of stavudine, lamivudine, and nevirapine on CD4cell counts and liver function parameters of 150 adult patients with a mean age of 34 years for 1 year. The measurement of serum alkaline phosphates, billirubin, and aminotransferases was analyzed using the reflection machine. Statistical Analysis Used: Data generated were analyzed using SPSS version 20.0. Logistic regression analysis was used to identify the significant predictors. Results: Of the 150 patients enrolled for the study, only 120 (180%) of them consisting of 82 (68.3%) males and 38 (31.7%) females were consistent with respect to adherence to therapy and submission to laboratory assessment. The findings of this study showed that CD4T-Cells, bilirubin, and alkaline phosphates had statistically significant changes (P > 0.05). Conclusions: Although the treatment outcome of patients with ARV indicates good response, evidence points to severe hepatocellular damage which may become life-threatening, especially for long-term users. We therefore recommend regular livers enzyme profile assessment as part of the integrated management of HIV/AIDS patients on ARV therapy.
Keywords: Antiretroviral therapy, enzymes, human immunodeficiency virus/acquired immune deficiency syndrome, liver, patients
|How to cite this article:|
Kumurya AS, Auta SA. Liver function parameters of patients on antiretroviral therapy attending al-noury specialist hospital Kano, Nigeria. Niger J Exp Clin Biosci 2020;8:40-3
|How to cite this URL:|
Kumurya AS, Auta SA. Liver function parameters of patients on antiretroviral therapy attending al-noury specialist hospital Kano, Nigeria. Niger J Exp Clin Biosci [serial online] 2020 [cited 2020 Oct 23];8:40-3. Available from: https://www.njecbonline.org/text.asp?2020/8/1/40/291193
| Introduction|| |
Human immunodeficiency virus (HIV) infection has become a global phenomenon, causing deaths in millions of infected people all over the world, especially in sub-Saharan Africa. The hallmark of HIV/acquired immune deficiency syndrome (AIDS) infection is the depletion of CD4 hearing cells, especially the T helper cells, resulting in impairment of cellular immune response. However, the introduction of potent antiretroviral (ARV) therapy has brought some relief in the care of patients infected with HIV/AIDS. The therapy has trained HIV/AIDS infection into a clinically manageable disease by promoting the asymptomatic phase of the infection. The drugs fall into two categories, namely the nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs). The NRTI mechanism of action is due to its resemblance of normal purine and pyrimidine bases so that during nucleic acid synthesis, the viral reverse transcriptase enzymes incorporate these molecules into the growing chain of DNA, thereby blocking its completion, while the PIs prevent viral protein synthesis and halt its assembly and release process from infected lymphocytes., Despite the positive impact of these drugs in the management of patients with HIV/AIDS, serious side effects and toxicity have been reposed among users., We evaluated the effects of fixed dose combination of lamivudine, stavudine, and didanosine on liver parameters for a period of 1 year including the CD4 T-cell outcomes during the same period. The study was conducted to evaluate the liver function parameters of patients ARV therapy attending Al-Noury Specialist Hospital Kano, Nigeria.
| Subjects and Methods|| |
This study was carried out in Al-Noury Specialist Hospital in Kano, North-Western Nigeria. The hospital has a center designated for the treatment of HIV/AIDS patients with functional laboratory facilities established as part of an ongoing prospective cohort. The hospital serves a large number of HIV/AIDS patients from within and outside Kano state.
The subjects for this were confirmed HIV/AIDS patients with CD4T lymphocyte count <500 cells/μl. They were confirmed positive using the Western Blot method (BIO-RAD).
Ethical approval for this study was obtained from the Ethical Committee of Al-Noury Specialist Hospital. In addition, individual patient's consent was obtained, and the purpose of the study was made known to them in both English and local dialects.
Blood samples were collected by vein puncture. Sampling was done in four stages: baseline (prior to administration of the first ARV therapy), 3 month, 6 months, and 12 months on ARV therapy. Five milliliters of blood samples were collected and all samples were analyzed the same day of collection.
Confirmation of human immunodeficiency virus status
Prior to the initiation of therapy, the HIV serostatus of the patient was confirmed. Serum from each patient was tested using the double rapid test with Determine, Uni-Gold, and Stat-pak as complete algorithm. Furthermore, confirmation was done using the Western Blot (BIO-RAD) assay method.
CD4T cell count
Five milliliters of blood samples were collected from each patient into ethylenediamine tetraacetic acid containers and analyzed using the Flow cytometer Autoanalyzer (Partec CyFlow, Germany). Subjects were assigned to four groups on the basis of their CD4T-cell counts.
Determination of liver enzymes
The measurement of serum alkaline phosphates, bilirubin, and aminotransferases was analyzed using the Reflotron Plus Chemistry Analyzer (Roche Diagnostics) as adopted by Cheesbrough.
Data generated were analyzed analyzed using the Statistical Package for the Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA). Categorical data were analyzed using the Chi-square test. Logistic regression analysis was used to identify the significant predictors. P < 0.05 was considered statistically significant at a 95% confidence interval.
| Results|| |
Of 150 patients enrolled for the study, only 120 (180%) of them consisting of 82 (68.3%) males and 38 (31.7%) females were consistent with respect to adherence to therapy and submission to laboratory assessment. Eighteen of the patients were lost to follow-up, a situation attributed to change of location due to societal stigmatization of HIV/AIDS patients. All efforts to trace them through the addresses provided in the hospital records failed, while 12 of the patients died during the period of the study.
Subjects were grouped into four based on their baseline CD4T-cell counts: Group 1 had CD4T-cell counts <100; Group 2 had CD4T-cell counts of 1 Group 3 had CD4T-cell counts of 201–350; and Group 4 had CD4T-cell counts of 351–500, while their mean age were 29, 83, 32.02, 32, 51, and 34.33 years, respectively [Table 1].
The CD4 T-cell count showed a significant positive outcome among the various groups, while the alkaline phosphate showed an increase within the first 3 months and a later decline within the normal range in Groups 2, 3, and 4 [Table 2]. The total bilirubin value showed a significant increase, especially in Groups 1 and 2.
|Table 2: Time course change in the mean values of CD4 T-cell counts and liver function analyzed among group of patients|
Click here to view
| Discussion|| |
ARV therapy has been acknowledged as a good remedy to the threat of HIV/AIDS infection in the society., However, noticeable and life-threatening side effects and organ toxicity have been reported among users., Many researchers have reported severe hepatotoxicity as a militating factor against compliance., Our studies revealed a significant increase in alkaline phosphate levels within the first 6 months and a slight decline at the 12th month and correlated strongly with CD4 outcome. Furthermore, noticeable was a significant increase in serum bilirubin among the recipients. This finding is in agreement with that of Sheng et al.'s study who reported hepatocellular damage among users of the right ventricular. Such liver toxicity bad earlier been reported by Moyle et al. as being associated with lactic acidosis and hepatic steatosis which are thought to be related to mitochondrial dysfunction secondary to the inhabitation of mitochondrial DNA polymerase gama. This effect has been attributed to most NRTI regimens. It has also been reported that nevirapine being an inducers of cytochrome P450 enzyme system is associated with gama-glutamyltransferase elevation, the same was as PIs. Although most transaminase enzymes were stable in the course of our study, this observation may require further investigation. Our findings also showed an elevation of bilirubin among the patients studied, and this is also in agreement with the findings of other workers, who reported hyperbilirubinemia among most recipients of ARV.,
Immunopathological mechanism has also been advanced as possible reason for hepatocellular damage during therapy. This may be due repairs of the immune system as indicated by rising CD4 lymphocyte count which is associated with development of anti HIV immune complex in the host and such complex can selectively be deposited in different organs including the liver and thus cause hepatocellular injury., Pouti et al. have proposed other immune mechanisms for cellular damage to include the fact that most HIV/AIDS patients have high titer of antibody to other opportunistic infections and gut-associated bacterial infections which may give rise to antibody-dependent cellular toxicity. There is evidence that immune reconstitution may also unmask previously undiagnosed infection such as hepatitis B and C. This is due to improved inflammatory response as a result of repaired immune system.,,
| Conclusions|| |
Although the treatment outcome of patients with ARV indicates good response, evidence points to severe hepatocellular damage which may become life-threatening, especially for long-term users. We therefore recommend regular monitoring of the recipient of AVR.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haase AT. Population biology of HIV-1 infection: Viral and CD4+ T cell demographics and dynamics in lymphatic tissues. Annu Rev Immunol 1999;17:625-56.
Grossman Z. CDT4 cell depletion in HIV Are we close to understanding the cause? Nat Med 2002;8:319332.
Yemi PG, Hammer SM, Carpenter CC. ARV treatment for adult HIV infection. JAMA 2002;288:22-35.
Pallela EJ, Deloria Knol M, Chinel JS. Survival benefit of imitation HIV infected person in different CDT4 cells strata. Ann Interm Med 2003;138:620-6.
Vincent S, Massimo P, Pilar G, Juergen KR, Yves B, Pablo B. Antiretroviral Drugs and Liver Injury. Mediscape AIDS 2008;22:1-13.
Derick NM, Christian O, Vincent F, Isaac A, Mavis D. National Institutes of Health Clinical Center; 2015.
Moyle M, Loyd G, Renold M. A Randomized Open Table Comparative Trials of Dietary Advice with and without Parasan for the Management of Protease Inhibitors Associated Hyprechotemia? Program and Abstract of the xiii Int. AIDS Conference; 2000.
Spinneti A, Pouti M, Donaco E. Increase Liver-Related in Hospital Morality in a Cohort of Italian HIV Seropositive of Introducing of HAART; Role OF HEPATITIS VIRUS to Infection. Prog and Abstract of the xiii International AIDS Conf; 2000.
Manuela GN, Michelle S, Radu MN, CharlesP. Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a “special population”?. Int J Hepatol 2012;23:760.
Jaffaris S, Govande T, Garide A. ARV treatment in poor resources setting: Public health research priorities. J Trop Med Inter Health 2005;10:295-9.
Safren SA, Kumarsamy N, James R. ART adherence demographic variable and CD4 outcome among HIV positive patients of ARV therapy in Chennai, India. AIDS Care 2005;17:853-62.
Sheng WH, Hsieh SM, Lee S. Fatal lactic acidosis associated with HARRT in patients with advanced HIV infection in Taiwan. Int J STD AIDS 2004;15:249-53.
Idigbe EO, Adewole TA, Eisien G, Kanki P, Odunkwe NN. Management of HIV infection with a combination of nevirapine, stavudine and Lamivudine: A preliminary report on Nigeria ARV programme. J AIDS 2005;40:65-9.
Sulkowski MS, Thomas DI, Chaisson RE. Hepatotoxicity associated with ARV theraphy in adults infected with HIC and role of hepatitis B or C virus infection. JAMA
Pouti M, Torti G, Ripamonti D. Life Threatening Hepatoxicity during Combination ARV Treatment. Program and Abstract of Abstract of XIII International AIDS Conference, Durban, South Africa; 2000.
Kohler JJ, Lewis W. A brief overview of mechanism of mitochondrial toxicity from NRTIs. Environ Mol Mutage 2007;48:166-72.
Guedlines for the use of Antiretroviral (ARV) Drugs in Nigeria. Abuja Nigeria: FMOH; 2009.
[Table 1], [Table 2]