Long-Term Effect of Different Classes of Highly Active Antiretroviral Therapy on Transaminases

AIM: The current use of highly active antiretroviral therapy (HAART) for HIV/AIDS patients has increased the recognition of their hepatotoxic effects. The present study is aimed at evaluating the level of aspartate transaminase (AST) and alanine transaminase (ALT) in HIV patients on different classes of HAART, for various durations, which causes its toxicity. MATERIALS AND METHODS: The AST and ALT levels were estimated in a total of 340 subjects, of which 290 were HIV positive subjects drawn from patients attending the HIV clinic in two Teaching Hospitals, in Nigeria. 240 of the HIV patients were divided into 3 equal groups of 80 each and placed on non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI), and protease inhibitors (PI), respectively, and were monitored for different periods of time (3, 6, 12, and >12 months). 50 of the HIV patients, yet to be placed on anti-retroviral therapy and 50 apparently healthy HIV-negative subjects served as the positive and negative controls, respectively. RESULTS: A significant increase in enzyme levels was noted at three and six months in the NNRTI group, and at only three months in the NRTI and PI groups, when compared with the controls. However, increased ALT was observed at six months in those on PI. The increased ALT and AST levels noted in the NNRTI group were significant when compared to those on NRTI and PI over a three- and six-month duration. CONCLUSION: Liver enzyme activities were generally raised in the first three months of HAART, and further in the NNRTI group, after which they progressively fell to the normal level, with time. The highest degree was observed with NNRTI-based HAART.