Prevalence of baseline transaminitis in ARV naive HIV infected children and the role of routine LFT monitoring at the University Teaching Hospital, Lusaka, Zambia

Abstract

The advent of antiretroviral therapy (ART) has made an impressive impact in the management of HIV infection. However, ART can be responsible for a wide range of toxicities, from low-grade intolerance that may be self-limiting, to life-threatening side-effects. In assessing drug toxicity, mild elevations of serum transaminases are commonly seen and often improve despite continued administration of the same drug. Studies in adult patients have shown that first-line ART can be delivered safely without routine biochemistry monitoring for toxic effects, and therefore routine hepatic function monitoring during ART is no longer considered as essential. Elevations in serum liver enzyme levels have been described in relation to all the major classes of antiretroviral drugs. However, there are few data on liver toxicity among the paediatric population receiving ART in developing countries. This was a cross sectional study involving review of patient medical files for 294 children initiated on ART in 2012 and follow-up from initiation to 6-months. The study was concluded at the University Teaching Hospital, Paediatric HIV/AIDS Centre of Excellence in Lusaka, Zambia. Baseline prevalence of transaminitis (Grade ≥ 2) was 5.5%. At 3 months incidence of transaminitis was 2.9%. At 6 months incidence of transaminitis was 1.4%. Neither age nor CD4 count was significantly correlated with ALT at baseline, 3 months or 6 months. There was significant difference in mean ALT at baseline and 6 months, P-value = 0.037. There was no significant difference between mean ALT at baseline and 3 months, P-value = 0.19. This study showed that the prevalence of baseline transaminitis in HIV infected children is low. Therefore, there will be no benefit in laboratory monitoring as a routine for liver toxic effects in HIV infected children receiving ART. The normalization of initial liver enzyme elevations despite continued therapy suggests that transaminase measurements should not be done frequently because, in most cases, the additional tests are unlikely to influence subsequent patient management. The indiscriminate use of these tests may confer additional costs to already constrained health systems in limited resource settings