Liver Enzyme Abnormalities: A Comparative Study between Treatment Naïve HIV and HIV Negative Hospital Patients

Ganiyat Oyeleke^1, and Anele Ihekwaba²

¹Lagos University Teaching Hospital, Lagos State, Nigeria

²University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Cite this paper:
Ganiyat Oyeleke and Anele Ihekwaba. Liver Enzyme Abnormalities: A Comparative Study between Treatment Naïve HIV and HIV Negative Hospital Patients. American Journal of Medical Sciences and Medicine. 2018; 6(2):45-50. doi: 10.12691/ajmsm-6-2-6

Abstract

Background and Aims: The prevalence of People living with human Immunodeficiency virus remains considerably high in Nigeria. Liver disease has emerged as an increasingly significant contributor to mortality among HIV-infected patients. The aim of our study was to compare the difference in the prevalence of liver enzyme abnormalities between treatment naïve HIV positive and HIV negative patients. Method: The study was conducted at a teaching hospital. The study population consists of 736 patients (368 cases and 368 controls) that were selected from the hospital. The cases were treatment naïve HIV patients and the controls were patients being managed for other diseases. A diagnosis of liver disease was made based on the diagnostic criteria which include; presence of at least one clinical feature of liver disease, two liver chemistry abnormalities and an abnormal hepatic ultrasound report. Result: The mean ages of the cases and controls were 35.97±9.77 and 36.08±9.54 years respectively. Liver disease was seen in 277 (75.3%) of the cases and 54 (14.7%) of the controls, this difference was statistically significant (p<0.001). Alkaline phosphatase ALP (p<0.001) and Gamma-glutamyl transferase GGT (p=0.04) were indicative of the presence of liver diseases in univariate analysis. Although Bilirubin was not of statistical significance, all HIV infected patients with total bilirubin ≥ 25.5µmol/L had liver diseases. Conclusion: The use of abnormal liver enzymes and clinical features in resource poor settings are valuable screening tools to indicate the presence of liver diseases particularly in HIV – infected patients.

Keywords:
liver enzyme abnormalities HIV treatment naïve HIV patients Nigeria

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References:

[1]	WHO | HIV/AIDS. WHO Available at: http://www.who.int/gho/hiv/en/. (Accessed: 6th March 2018).
[2]	Awofala, A. A. & Ogundele, O. E. HIV epidemiology in Nigeria. Saudi J. Biol. Sci. (2016).
[3]	Nigeria. Available at: http://www.unaids.org/en/regionscountries/countries/nigeria. (Accessed: 18th March 2018).
[4]	Fettig, J., Swaminathan, M., Murrill, C. S. & Kaplan, J. E. Global Epidemiology of HIV. Infect. Dis. Clin. North Am. 28, 323-337 (2014).
[5]	Jung, A. C. & Paauw, D. S. Diagnosing HIV-Related Disease. J. Gen. Intern. Med. 13, 131-136 (1998).
[6]	Phillips, A. N., Neaton, J. & Lundgren, J. D. The Role of HIV in Serious Diseases Other than AIDS. AIDS Lond. Engl. 22, 2409-2418 (2008).
[7]	Sherman Kenneth E., Peters Marion G. & Thomas David. Human immunodeficiency virus and liver disease: A comprehensive update. Hepatol. Commun. 1, 987-1001 (2017).
[8]	Price, J. C. & Thio, C. L. Liver Disease in the HIV-Infected Individual. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 8, 1002-1012 (2010).
[9]	UNAIDS_Global_Report_2013_en.pdf.
[10]	Weber, R. et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch. Intern. Med. 166, 1632-1641 (2006).
[11]	DallaPiazza, M., Amorosa, V. K., Localio, R., Kostman, J. R. & Lo Re, V. Prevalence and risk factors for significant liver fibrosis among HIV-monoinfected patients. BMC Infect. Dis. 10, 116 (2010).
[12]	Beek, J. H. D. A. van et al. The Genetic Architecture of Liver Enzyme Levels: GGT, ALT and AST. Behav. Genet. 43, 329-339 (2013).
[13]	Pratt, D. S. & Kaplan, M. M. Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients. N. Engl. J. Med. 342, 1266-1271 (2000).
[14]	Agrawal, S., Dhiman, R. K. & Limdi, J. K. Evaluation of abnormal liver function tests. Postgrad. Med. J. 92, 223-234 (2016).
[15]	R Core Team (2014). R: A language andenvironment for statisticalcomputing. R Foundation for Statistical Computing, Vienna, Austria.
[16]	Ejilemele, A. A., Nwauche, C. A. & Ejele, O. A. Pattern of abnormal liver enzymes in HIV patients presenting at a Nigerian Tertiary Hospital. Niger. Postgrad. Med. J. 14, 306-309 (2007).
[17]	Richardson, E. T. et al. Gender inequality and HIV transmission: a global analysis. J. Int. AIDS Soc. 17, (2014).
[18]	Langen, T. T. Gender power imbalance on women’s capacity to negotiate self-protection against HIV/AIDS in Botswana and South Africa. Afr. Health Sci. 5, 188–197 (2005).
[19]	Harries, K. et al. Baseline characteristics, response to and outcome of antiretroviral therapy among patients with HIV-1, HIV-2 and dual infection in Burkina Faso. Trans. R. Soc. Trop. Med. Hyg. 104, 154-161 (2010).
[20]	Terzic, D. et al. Liver enlargement associated with opportunistic infections in patients with human immunodeficiency virus infection. J. Gastrointest. Liver Dis. JGLD 17, 401-404 (2008).
[21]	Smith, C. J. et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet Lond. Engl. 384, 241-248 (2014).
[22]	Skelly, M. M., James, P. D. & Ryder, S. D. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J. Hepatol. 35, 195-199 (2001).
[23]	Shiferaw, M. B., Tulu, K. T., Zegeye, A. M. & Wubante, A. A. Liver Enzymes Abnormalities among Highly Active Antiretroviral Therapy Experienced and HAART Naïve HIV-1 Infected Patients at Debre Tabor Hospital, North West Ethiopia: A Comparative Cross-Sectional Study. AIDS Research and Treatment (2016).
[24]	Lucien, K., Clement, A., Fon, N., Weledji, P. & Ndikvu, C. The effects of antiretroviral treatment on liver function enzymes among HIV-infected out patients attending the Central Hospital of Yaounde, Cameroon. Afr. J. Clin. Exp. Microbiol. 11, (2010).
[25]	Ch’ng, C. L., Morgan, M., Hainsworth, I. & Kingham, J. G. C. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 51, 876-880 (2002).
[26]	Ocama, P. et al. The spectrum of liver diseases in HIV infected individuals at an HIV treatment clinic in Kampala, Uganda. Afr. Health Sci. 8, 8-12 (2008).
[27]	Spinella, R., Sawhney, R. & Jalan, R. Albumin in chronic liver disease: structure, functions and therapeutic implications. Hepatol. Int. 10, 124-132 (2016).
[28]	Bernardi, M., Maggioli, C. & Zaccherini, G. Human albumin in the management of complications of liver cirrhosis. Crit. Care 16, 211 (2012).
[29]	Boyd, A., Lacombe, K. & Girard, P.-M. An improved understanding of severe liver morbidity in HIV-infected individuals. AIDS 30, 1843 (2016).