Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy
CONTEXT AND OBJECTIVE: Adverse drug reactions are a significant problem in patients on antiretroviral therapy (ART). We determined liver enzyme elevation frequencies in HIV-infected children and adolescents receiving ART, and their association with risk factors. DESIGN AND SETTING: Cross-sectional s...
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| Format: | Article |
| Language: | English |
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Associação Paulista de Medicina
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| Series: | São Paulo Medical Journal |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802007000400002&lng=en&tlng=en |
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| author | Ana Cecília Montes Gil Raquel Lorenzetti Gun Bergsten Mendes André Moreno Morcillo Adyléia Aparecida Dalbo Contrera Toro Marcos Tadeu Nolasco da Silva Maria Marluce dos Santos Vilela |
| author_facet | Ana Cecília Montes Gil Raquel Lorenzetti Gun Bergsten Mendes André Moreno Morcillo Adyléia Aparecida Dalbo Contrera Toro Marcos Tadeu Nolasco da Silva Maria Marluce dos Santos Vilela |
| author_sort | Ana Cecília Montes Gil |
| collection | DOAJ |
| description | CONTEXT AND OBJECTIVE: Adverse drug reactions are a significant problem in patients on antiretroviral therapy (ART). We determined liver enzyme elevation frequencies in HIV-infected children and adolescents receiving ART, and their association with risk factors. DESIGN AND SETTING: Cross-sectional study, at the Pediatrics Immunodeficiency Division, University Hospital, Universidade Estadual de Campinas. METHODS: Medical records of 152 children and adolescents (54.6% male; median age 7.48 years) were analyzed, with a mean of 2.6 liver enzyme determinations per patient. Clinically, patients were classified in categories N (6), A (29), B (78) and C (39). Serum levels of aspartate aminotransferase and alanine aminotransferase were evaluated. Hepatotoxicity was scored as grade 1 (1.1-4.9 times upper limit of normality, ULN), grade 2 (5.0-9.9 times ULN), grade 3 (10.0-15.0 times ULN) and grade 4 (> 15.0 times ULN). To assess hepatotoxicity risk factors, odds ratios (OR) and adjusted odds ratios (aOR) for age, gender, TCD4+ cell count, viral load and medication usage were calculated. RESULTS: We observed grade 1 hepatotoxicity in 19.7 % (30/152) patients. No cases of grade 2, 3 or 4 were detected. There was a significant association between hepatotoxicity and use of sulfonamides (OR, 3.61; 95% confidence interval (CI), 1.50-8.70; aOR, 3.58; 95% CI, 1.44-8.85) and antituberculous agents (OR, 9.23; 95% CI, 1.60-53.08; aOR, 9.05; 95% CI, 1.48-55.25). No toxicity was associated with ART. CONCLUSIONS: One fifth of patients experienced mild hepatotoxicity, attributed to antituberculous agents and sulfonamides. Our results suggest that ART was well tolerated. |
| first_indexed | 2024-12-10T03:56:23Z |
| format | Article |
| id | doaj.art-10fed2e957164bdd9024ac222b911e76 |
| institution | Directory Open Access Journal |
| issn | 1806-9460 |
| language | English |
| last_indexed | 2024-12-10T03:56:23Z |
| publisher | Associação Paulista de Medicina |
| record_format | Article |
| series | São Paulo Medical Journal |
| spelling | doaj.art-10fed2e957164bdd9024ac222b911e762022-12-22T02:03:05ZengAssociação Paulista de MedicinaSão Paulo Medical Journal1806-9460125420520910.1590/S1516-31802007000400002S1516-31802007000400002Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapyAna Cecília Montes Gil0Raquel Lorenzetti1Gun Bergsten MendesAndré Moreno Morcillo2Adyléia Aparecida Dalbo Contrera Toro3Marcos Tadeu Nolasco da Silva4Maria Marluce dos Santos Vilela5Universidade Estadual de CampinasUniversidade Estadual de CampinasUniversidade Estadual de CampinasUniversidade Estadual de CampinasUniversidade Estadual de CampinasUniversidade Estadual de CampinasCONTEXT AND OBJECTIVE: Adverse drug reactions are a significant problem in patients on antiretroviral therapy (ART). We determined liver enzyme elevation frequencies in HIV-infected children and adolescents receiving ART, and their association with risk factors. DESIGN AND SETTING: Cross-sectional study, at the Pediatrics Immunodeficiency Division, University Hospital, Universidade Estadual de Campinas. METHODS: Medical records of 152 children and adolescents (54.6% male; median age 7.48 years) were analyzed, with a mean of 2.6 liver enzyme determinations per patient. Clinically, patients were classified in categories N (6), A (29), B (78) and C (39). Serum levels of aspartate aminotransferase and alanine aminotransferase were evaluated. Hepatotoxicity was scored as grade 1 (1.1-4.9 times upper limit of normality, ULN), grade 2 (5.0-9.9 times ULN), grade 3 (10.0-15.0 times ULN) and grade 4 (> 15.0 times ULN). To assess hepatotoxicity risk factors, odds ratios (OR) and adjusted odds ratios (aOR) for age, gender, TCD4+ cell count, viral load and medication usage were calculated. RESULTS: We observed grade 1 hepatotoxicity in 19.7 % (30/152) patients. No cases of grade 2, 3 or 4 were detected. There was a significant association between hepatotoxicity and use of sulfonamides (OR, 3.61; 95% confidence interval (CI), 1.50-8.70; aOR, 3.58; 95% CI, 1.44-8.85) and antituberculous agents (OR, 9.23; 95% CI, 1.60-53.08; aOR, 9.05; 95% CI, 1.48-55.25). No toxicity was associated with ART. CONCLUSIONS: One fifth of patients experienced mild hepatotoxicity, attributed to antituberculous agents and sulfonamides. Our results suggest that ART was well tolerated.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802007000400002&lng=en&tlng=enAidsPediatricsHighly active antiretroviral therapyDrug toxicityAnti-bacterial agents |
| spellingShingle | Ana Cecília Montes Gil Raquel Lorenzetti Gun Bergsten Mendes André Moreno Morcillo Adyléia Aparecida Dalbo Contrera Toro Marcos Tadeu Nolasco da Silva Maria Marluce dos Santos Vilela Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy São Paulo Medical Journal Aids Pediatrics Highly active antiretroviral therapy Drug toxicity Anti-bacterial agents |
| title | Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy |
| title_full | Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy |
| title_fullStr | Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy |
| title_full_unstemmed | Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy |
| title_short | Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy |
| title_sort | hepatotoxicity in hiv infected children and adolescents on antiretroviral therapy |
| topic | Aids Pediatrics Highly active antiretroviral therapy Drug toxicity Anti-bacterial agents |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802007000400002&lng=en&tlng=en |
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