465. Elevated Alanine Aminotransferase (ALT) among Antiretroviral Naive HIV-infected Patients: Perspective from a Resource poor Country
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1

Alanine aminotransferase (ALT) is commonly used to measure liver function in resource limited settings. Elevations in ALT are predictive of increased mortality from liver disease, and may influence choice of first line antiretroviral therapy (ART).


A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as > 40 IU/L) was conducted. ART naïve, HIV-infected adults (>15 years) with a baseline ALT  who were enrolled at 18 President's Emergency Plan for AIDS Relief (PEPFAR) - supported Management and Development for Health HIV care and Treatment clinics in Dar es Salaam, Tanzania between November 2004 - June 2008 were included. Median values were calculated and robust linear regression models were used to examine predictors of elevated ALT (SAS version 9.2).


During the study period, 41,891 adults [women, 70.5%; mean age 35.7 (SD 9.7); CD4<200 cells/mm3, 53.7%], had a baseline ALT performed. The prevalence of ALT > 40 IU/L, 120 IU/L and 200 IU/L was (5301) 12.65%, (457) 1.09% and (141) 0.34%, respectively. In multivariate analyses, male sex, CD4 <200 vs. >200 cells/mm3 and WHO clinical stage IV vs. stage I, were associated with a significantly higher risk of ALT ≥40 IU/L (all p values <0.01). Each incremental increase in TG of 50g/dl was associated with a 17% increased risk of elevated ALT (p <0.01); hyperglycemia (random blood glucose > 200mg/dl or fasting blood glucose >140mg/dl) was also significantly associated with elevated ALT [RR 1.33 (95% CI 1.05, 1.69); p<0.01]. Patients with Hepatitis B co-infection (HbsAg+) had a significantly higher risk of elevated ALT in a sub analyses of 8037 patients with known Hepatitis B status [RR 1.39 (95% CI 1.17, 1.64)].  Pregnancy, anemia, LDL>130 mg/dl and current TB treatment were associated with significantly reduced risk for elevated ALT.


In this HIV-infected, ART-naïve, Tanzanian population, extreme elevations in ALT were infrequent but minor elevations were not uncommon. Antiretrovirals with potentially hepatotoxic side effects should be initiated with caution in males, patients with HBV co-infection, advanced immunosuppression and the metabolic syndrome.   

Subject Category: H. HIV/AIDS and other retroviruses

Tumaini Nagu, MD1, Mufaro Kanyangarara, Msc2, Claudia Hawkins, MD3,4, James Okuma, MS5, Hertmark Hertmark, MA6, Guerino Chalamila, MD PhD7, Donna Spiegelman, PHD8, Ferdinand Mugusi, MD9 and Wafaie Fawzi, MD, MPH, DrPH5, (1)Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, (2)2Management for Development and Health (MDH) HIV/AIDS Care and Treatment Program, Dar es Salaam, Tanzania, Dar es Salaam, Tanzania, (3)Northwestern University Feinburg School of Medicine, Chicago, IL, (4)MDH HIV/AIDS Care and Treatment Program, Muhumbili University of Health and Allied Sciences, Chicago, IL, (5)Harvard School of Public Health, Boston, MA, (6)Harvard School of Public Health, Boston, MA, USA, Boston, MA, (7)Management for Development and Health MDH HIV/AIDS Care and Treatment , Dar es Salaam, Tanzania, (8)Harvard University School of Public Health, Boston, MA, (9)Muhimbili University of Health and Allied Sciences (MUHAS) , Dar es Salaam, Tanzania


T. Nagu, None

M. Kanyangarara, None

C. Hawkins, None

J. Okuma, None

H. Hertmark, None

G. Chalamila, None

D. Spiegelman, None

F. Mugusi, None

W. Fawzi, None

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