Abstrak
Background: Higher mortality rates were reported in developing countries during early months of HAART initiation than in developed countries. The study aimed at assessing the effect of Highly Active Antiretroviral Therapy (HAART) on liver function of under-fives.
Method: Two hundred and thirty-eight under-fives children were enrolled from five hospitals in Southern Nigeria. Ethical permission and written consent were obtained. Group A involved 91 seropositive-children on HAART regimen while Group B1 involved 24 seronegative-infants who received nevirapine from birth till age 6-week. Group B2 (18) and B3 (48) involved seronegative-children who received co-trimoxazole and were 6-month and 18-month old respectively. Group C involved 11 seropositive-children who received co-trimoxazole only. Group D involved 46 seronegative-children who served as the control group. A 2ml blood sample was obtained from each participant during first phase of the study and was analysed for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) using kits manufactured by Randox®. Group A children returned for second and third phases of the study after 3-month and 6-month respectively. Data were analysed by using ANOVA.
Results: The results showed that ALT was highest in group A (12.8±11.0IU/L) suggesting hepatotoxicity while AST was highest in group B2 (35.4±53.1IU/L). Second phase, ALT and AST of group A were significantly reduced by 39.3% (p<0.05), 29.9% (p<0.05) respectively suggesting resolved hepatotoxicity. Third phase, ALT and AST were significantly reduced by 50.6% (p<0.05) and 32.2%(p<0.05) respectively suggesting resolved hepatotoxicity.
Conclusion: Hepatotoxicity observed among HIV-infected children on HAART was resolved after 6-month of monitoring.
Keywords: Under-five HIV children, ALT, AST, resolved hepatotoxicity, HAART
Résumé
Contexte: Des taux plus élevés de mortalité ont été signalés dans les pays en voie de développement au cours des premiers mois d’initiation à l’HAART que dans les pays développés. L’étude visait à évaluer l’effet de la thérapie antirétrovirale hautement active (HAART) sur la fonction hépatique des enfants moins de cinq ans.
Méthode: Deux cent trente-huit enfants, moins de cinq ans, étaient enrôlés provenant de cinq hôpitaux dans le sud du Nigeria. Permission éthique et consentement écrits ont été obtenus. Groupe A compris 91 enfants séropositifs surtraitement HAART tandis que le groupe B1 compris 24 enfants séronégatifs qui ont reçu la névirapine dès la naissance jusqu’à l’âge de 6 semaines. Le groupe B2 (18) et B3 (48) compris d’enfants séronégatifs qui ont reçu le co-trimoxazole et étaient de 6 mois et de 18 mois respectivement. Groupe C compris 11 enfants séropositifs qui ont reçu le co-trimoxazole seulement. Groupe D compris 46 enfants séronégatifs qui ont servi de groupe témoin. Un échantillon de 2 ml de sang a été obtenu provenant de chaque participant lors de la première phase de l’étude et a été analysé pour l’alanine amino-transférase (ALT) et aspartate amino-transférase (AST) en utilisant des kits fabriqués par Randox®. Les enfants du groupe A se sont retournés pour la deuxième et la troisième phase de l’étude, après 3 mois et 6 mois respectivement. Les données ont été analysées en utilisant ANOVA.
Résultats: Les résultats ont montré que ALT était le plus élevé dans le groupe A (12,8 ± 11.0IU / L) suggérant l’hépato-toxicité tandis que AST était le plus élevé dans le groupe B2 (35,4 ± 53.1IU / L). Deuxième phase, ALT et AST du groupe A ont été significativement réduites de 39,3% (p <0,05), 29,9% (p <0,05) suggérant respectivement hépato-toxicité résolu. Troisième phase, ALT et AST ont été significativement réduites de 50,6% (p <0,05) et 32,2% (p <0,05) suggérant respectivement hépato-toxicité résolu.
Conclusion: Hépato-toxicité observé chez les enfants infectés par le VIH sous l’HAART a été résolu après 6 mois de suivi.
Mots-clés: Enfants VIH moins de cinq ans, ALT, AST, hépato-toxicité résolu, HAART
Correspondence: Dr. M.O. Ajulo, Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Uyo, Uyo, Nigeria. E-mail: ajugbeng@gmail.com
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