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Antiretroviral-therapy-related Hepatotoxicity in HIV-infected Children in Integrated HIV-care Clinic, Mandalay Childrens Hospital, Myanmar

Wai Lin Tun, Khaing KW and Tin M

Objectives: To determine the incidence and severity of antiretroviral-therapy-related hepatotoxicity in HIV infected children in the local population and to relate hepatotoxicity with patient characteristics such as age, gender, baseline aminotransferase levels, clinical stages and immunologic categories at the initiation of antiretroviral therapy (ART) and types of ART, in the Integrated HIV-care Clinic, Mandalay Children’s Hospital, Myanmar.

Method: This study was performed on 68 HIV-infected children in 2010. They were followed up for 8 weeks from the start of ART. Serum ALT and AST levels were measured before the initiation of ART, and then again at 2 weeks, 4 weeks and 8 weeks from the start of ART. The severity of hepatotoxicity was determined by the highest level of ALT or AST during the first eight weeks. Patients with documented pre-existing liver diseases or Hepatitis B virus or Hepatitis C virus co-infections, those who were currently on anti-tuberculous drugs, and those with grade 2, 3, 4 liver enzyme elevations at baseline, were excluded.

Result: Out of 68 patients, 18 patients (26.5%) suffered some degree of hepatotoxicity. Most patients (16 patients) had mild hepatotoxicity. Severe hepatotoxicity (grade 3 or 4) was observed in 2 patients. Hepatotoxicity was found to be more common in patients with normal baseline liver enzyme levels than those with elevated baseline liver enzyme levels (P=0.035). No statistically significant relation was found between the occurrence or severity of hepatotoxicity and patients’ other characteristics such as age, gender, WHO clinical stages, immunologic categories and types of ART.

Conclusion: Although hepatotoxicity was frequently observed in children who were newly started on ART, most cases were of mild degree (grade 1 or 2 hepatotoxicity). The occurrence or severity of hepatotoxicity was not attributable to patient characteristics except baseline liver enzyme levels.