LIVER FUNCTION ASSESSMENT IN HIV PATIENTS UNDER ANTIRETROVIRAL THERAPY
DOI:
https://doi.org/10.56238/arev7n11-257Keywords:
HIV, ART, Elevated Liver Enzymes, HepatotoxicityAbstract
Despite advances in antiretroviral therapy (ART), HIV remains one of the leading causes of death in some developing countries. HIV patients are at risk for biochemical abnormalities, including elevated liver enzymes, which are common among ART users. A retrospective descriptive study was conducted involving HIV patients on ART (2019–2025) at HDT-TO. Variables analyzed included sex, age, hospitalization period, ART regimen, liver enzymes, associated diseases, and reasons for admission.A total of 321 hospitalizations of 120 patients were analyzed, with a predominance of males (75.4%) and age between 20–39 years (39.2%), mainly from Araguaína-TO (54.2%). The most prescribed regimen was TDF + 3TC + DTG (54.3%). ART modifications occurred in 5.5% of cases due to hepatotoxicity, renal injury, anemia, or therapeutic failure. Elevated AST occurred in 58% and ALT in 35% of patients. The main hepatic complications included steatosis, viral hepatitis, and cirrhosis. The most frequent reasons for hospitalization were visceral leishmaniasis, neurotoxoplasmosis, and pneumocystosis. Alcohol use, antibiotics, antifungals, and protease inhibitors (atazanavir and ritonavir) increased the risk of hepatotoxicity. Hypoalbuminemia tripled the risk of severe hepatic complications. The results emphasize the importance of liver monitoring in HIV patients, particularly those with risk factors, and highlight the need for screening for viral hepatitis and opportunistic infections.
Downloads
References
AZEVEDO, Larissa Negromonte et al. Factors associated to modification of first-line antiretroviral therapy due to adverse events in people living with HIV/AIDS. The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases, v. 24, n. 1, p. 65–72, 2020.
BENEDICTO, Ana M. et al. NNRTI and liver damage: Evidence of their association and the mechanisms involved. Cells (Basel, Switzerland), v. 10, n. 7, p. 1687, 2021.
BRASIL. Ministério da Saúde. Brasil registra queda de óbitos por aids, mas doençaainda mata mais pessoas negras do que brancas. [Brasília]: Ministério da Saúde, 30 de novembro de 2023. Disponível em: https://www.gov.br/saude/ptbr/assuntos/noticias/2023/novembro/brasil-registra-queda-de-obitos-por-aids-masdoenca-ainda-mata-mais-pessoas-negras-do-que-brancas. Acesso em: 17 jul. 2024.
BRASIL. Ministério da Saúde. Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Adultos – Módulo I: Tratamento. Brasília: Ministério da Saúde; 2024. Disponível em:https://www.gov.br/aids/pt-br/central-de-conteudo/pcdts/pcdt_hiv_modulo_1_2024.pdf.
BRASIL. Ministério da Saúde. Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Adultos – Módulo II: Coinfecções e infecções oportunistas. Brasília: Ministério da Saúde; 2024. Disponível em:https://www.gov.br/aids/pt-br/central-de-conteudo/pcdts/pcdt_hiv_modulo_2 2024.pdf.
BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico HIV e Aids 2024. Brasília: Ministério da Saúde; 2024. Disponível em:https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2024/boletim_hiv_aids_2024e.pdf/view
BRIDI CAVASSIN, Francelise et al. Acute infusion-related side effects of amphotericin B lipid complex (ABLC) in oncohematological patients: Real-world data from Brazilian reference centers. Infectious diseases and therapy, v. 14, n. 1, p. 133–148, 2025.
ENDALE, Hiwot Tezera et al. Assessment of liver function test and associated factors among visceral leishmaniasis patients attending university of gondar leishmaniasis research and treatment center, Northwest Ethiopia. PloS one, v. 16, n. 11, p. e0260022, 2021.
FAUCI, A. S.; BRAUNWALD, E.; KASPER, D. L.; HAUSER, S. L.; LONGO, D. L.;JAMESON, J. L.; LOSCALZO, J. Medicina interna de Harrison. 19. ed. Porto Alegre:AMGH, 2017. 2 v.
GEBREMICAEL, G. et al. Incidence of hepatotoxicity and factors associated duringhighly active antiretroviral therapy in people living with HIV in Ethiopia: A prospectivecohort study. HIV/AIDS, v. 13, p. 329–336, 2021.
GIL, Antonio Carlos. Como elaborar projetos de pesquisa. 2. ed. SP: Atlas, 1991.
GU, Shaopeng et al. Drug-induced liver injury with commonly used antibiotics in the all of Us Research Program. Clinical pharmacology and therapeutics, v. 114, n. 2, p. 404–412, 2023.
GUO, Dongjie et al. Efficacy and toxicity analysis of ganciclovir in patients with cytomegalovirus lung infection: what is new for target range of therapeutic drug monitoring. Microbiology spectrum, v. 13, n. 8, p. e0046125, 2025.
HALL, Andrew M. et al. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. American journal of kidney diseases: the official journal of the National Kidney Foundation, v. 57, n. 5, p. 773–780, 2011.
HUANG, Rui et al. Association between admission serum albumin and 12-weeks mortality in patients with late AIDS/HIV diagnosis: a retrospective cohort study. Scientific reports, v. 14, n. 1, p. 18487, 2024.
LAKATOS, Eva e Marconi, Marina. Metodologia do Trabalho Científico. SP : Atlas,1992.
MARTINEZ DE NARVAJAS, Iratxe et al. Acute liver failure due to visceral leishmaniasis in Barcelona: a case report. BMC infectious diseases, v. 19, n. 1, p. 874, 2019.
MENDES, R. L. G. Hepatotoxicity in HIV-infected. Disponível em:https://www.scielo.br/j/spmj/a/Wp7ZtVwPsHSHbMrqw6GbJHq/?format=pdf&lang=en.Acesso em: 17 jul. 2024.
NEFF, G. W.; JAYAWEERA, D.; SHERMAN, K. E. Drug-induced liver injury in HIVpatients. Gastroenterology & Hepatology, v. 2, n. 6, p. 430, 2006.
ONYIRIMBA, Henry et al. Bactrim-induced hepatotoxicity. Cureus, v. 16, n. 11, p. e74053, 2024.
RUIZ, João Álvaro. Metodologia Científica: guia para eficiência nos estudos. 4. ed. SP: Atlas, 1996.
WANG, Zhenyan et al. Brief communication: efficacy and safety of the dolutegravir/lamivudine dual therapy in antiretroviral treatment-experienced Chinese people living with HIV. AIDS research and therapy, v. 21, n. 1, p. 86, 2024.
