Impact of highly active antiretroviral therapy on liver function of under-five HIV-positive children in Southern Nigeria

Background: Hepatotoxicity deserves serious attention due to mortality, morbidity and treatment discontinuation in HIV-seropositive patients.

Objectives: The study aimed at evaluating the impacts of Highly Active Antiretroviral Therapy (HAART) on liver function of under-five children in Southern Nigeria.

Method: In five hospitals, 238 under-five children were enrolled after ethical permission was received from Ethics and Research committees and written consent were obtained from participants' care-givers. Participants were divided into six groups: the HIV-seropositive either on HAART (group A, n= 91) or cotrimoxazole (group B, n= 11) and four other groups who were HIV-seronegative. Among this second cohort were those commenced on nevirapine for six weeks post-exposure (group C1, n= 24) and co-trimoxazole at 6 months (group C2, n= 18) or 18 months (group C3, n= 48) post-exposure. The last group received no medication (group D, n= 46). Initially, a blood sample of 2ml was obtained from each participant and was assayed for alanine aminotransferase (ALT) and aspartate aminotransferase (AST). After three- and six-months from the time of initial study, only group A participants were restudied for the liver enzymes' assay. Body mass index of the participants were also determined. Mean and standard deviation of the parameters of participants in group A was compared with those from other groups by using ANOVA. The differences in the parameters were considered significant at p≤0.05.

Results: Alanine aminotransferase (ALT) was significantly higher in group A compared to group B (12.8±11.0 IU/L vs 6.5±2.6 IU/L, p= 0.245), group C1 (12.8±11.0 IU/L vs 10.9±7.8 IU/L, p= 0.910), group C2 (12.8±11.0 IU/L vs 11.7±20.7 IU/L, p= 0.995), group C3 (12.8±11.0 IU/L vs 11.2±6.9 IU/L, p= 0.868), and group D (12.8±11.0 IU/L vs 5.8±3.4 IU/L, p= 0.001). After three and six months of monitoring, ALT of group A was significantly decreased by 39.3% (p= 0.001) and 50.6% (p= 0.000) respectively.

Conclusion: The elevated ALT of under-five HIV-infected children on HAART lowered after six months of monitoring.