Hepatotoxicity and associated risk factors in HIV-infected patients receiving antiretroviral therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia

Ethiop J Health Sci. 2013 Nov;23(3):217-26. doi: 10.4314/ejhs.v23i3.4.


Background: In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).

Methods: A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.

Results: Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1-4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 -2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36-3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15-3.74) independently predicts the elevation of ALT.

Conclusions: In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.

Keywords: ALT; ART; Bahir Dar; Ethiopia; HIV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alanine Transaminase / blood*
  • Alanine Transaminase / metabolism
  • Alcohol Drinking / adverse effects
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • CD4 Lymphocyte Count
  • Child
  • Cross-Sectional Studies
  • Ethiopia
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • HIV Seropositivity / blood
  • HIV Seropositivity / epidemiology
  • Hepatitis, Viral, Human / enzymology
  • Hepatitis, Viral, Human / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • RNA, Viral / metabolism
  • Young Adult


  • RNA, Viral
  • Alanine Transaminase