Liver function tests of HIV/AIDS patients at the nylon district hospital, Douala, Cameroon

Walter O. Ebot, Eric A. Achidi, Henri-Lucien F. Kamga, Anna L. Njunda, Tobias O. Apinjoh


Background: Antiretroviral therapy (ART) which substantially reduces morbidity and mortality in human immunodeficiency virus (HIV) seropositive patients has been associated with hepatotoxicity. This study was aimed at investigating the effects of HIV infection and ART on liver function amongst HIV seropositive patients in Douala, Cameroon.

Methods: A cross- sectional study was conducted from March to August, 2012 at the Nylon District Hospital, Douala. Demographic data were collected using a structured questionnaire.  Serum alanine and aspartate aminotransferases (ALT and AST), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) activities were determined using colorimetric techniques.

Results: The mean age of the study participants was 37.9 ± 6.02 years. A majority of the study participants (68.0%) were females. The mean CD4+ T lymphocyte cell count of HIV/AIDS patients on ART was significantly higher than the ART- naïve patients (p<0.05). The mean serum AST and ALT activities of ART-naïve patients were significantly higher than the control subjects (p<0.05). Similarly, the mean serum transaminases and GGT activities of HIV/AIDS patients on ART were significantly higher than the control subjects (p<0.05). The mean serum ALP and GGT activities of HIV/AIDS patients receiving ART were significantly higher than the ART- naïve patients (p<0.05).

Conclusions: The present study provides evidence to suggest that both infection with HIV and treatment with ART are associated with liver injury.



Human immunodeficiency virus, Antiretroviral therapy, Liver function enzymes, Hepatotoxicity

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The Joint United Nations Programme on HIV/AIDS. 2013 Report on the Global AIDS Epidemic. Available at http:// www.unaids/en/resources/campaigns/globalreport2013/globalreport.

World Health Organization. Summary Country Profile on HIV/AIDS Treatment Scale up, Geneva 2005:1-2. Assessed 13 December 2005.

Laurent C, Diakhate N, Gueye NF, Toure M, Sow P, Faye M, et al. The Senegalese government’s highly active antiretroviral therapy initiative; an 18-month follow-up study. Aids. 2002;16(10):1363-70.

Weidle P, Mwebaze R, Sozi C, Rukundo G, Downing R, Hanson D, et al. Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients’ response, survival and drug resistance. Lancet Infect Dis. 2002;6(360(9326)):34-40.

Sanne I, Mommeja-Marin H, Hinkle J, Bartlett J, Lederman M, Maartens G, et al. Severe hepatotoxicity associated with nevirapine use in HIV-infected subjects. J Infect Dis. 2005;191(6):825-9.

Dieterich D, Robinson P, Love J, Stern J. Drug-induced liver injury associated with the use of nonnucleoside reverse-transcriptase inhibitors Clin Infect Dis. 2004;38(Suppl 2):S8

Wnuk A. Liver damage in HIV-infected patients. Med Sci Monit. 2001; (7):729-36.

Servoss J, Sherman K, Robins G. Hepatotoxicity in the U.S Adult AIDS Clinical Trial Group. Gastroenterology. 2001;(120):A54.

Sulkowski M, Thomas D, Chaisson R, Moore R. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis virus C or B infection. JAMA 2000;(283):74-80.

Jahn J, Maier M, Byakika-Tusiime J, Oyugi J, Bangaberg D. Hepatotoxicity during nevirapine-based fixed dose combination antiretroviral therapy in Kampala, Uganda. J Int Assoc Physicians AIDS Care (Chic III). 2007;(6):83-6.

Mata-Marin J, Gaytan-Martinez J, Grados-Chavarría H, Fuentes-Allen J, Arroyo-Anduiza C, Alfaro-Mejia A. Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study. Virology Journal. 2009(6):181.

Ofotokun I, Smithson SE, Lu C, Easley KA, Lennox JL. Liver enzymes elevation and immune reconstitution among treatment-naïve HIV-infected patients instituting antiretroviral therapy. Am J Med Sci. 2007;334(5):334-41.

Gupta S, Singh S. Hepatitis B and C virus co-infection in human immunodeficiency virus positive North Indian patients. World J Gastroenterol. 2006;(14):6879-83.

Nakwagala F, Kagimu M. Hepatitis B virus and HIV infections among patients in Mulago Hospital. East Afr Med J. 2002;(79):68-72.

Navarro J, Senior J. Drug related hepatotoxicity. National England Journal of Medicine. 2006;(354):731-9.

Lewis J, Strom B. Balancing safety of dietary supplements with the free market. Annals of Internal Medicine. 2002(136):616-8.

The Joint United Nations Programme on AIDS. Global Update on HIV Treatment, 2013. Results, Impact and Opportunities. WHO Report in Partnership with UNICEF and UNAIDS, June 2013.

CDC/OMS. Classification du CDC, primo-infection a VIH1, diagnostic et prise en charge. 1993:18.

HIV Prevalence in Cameroon: Findings from the 2011 DHS-MICS. Available at

Joint United Nations Programme on HIV/AIDS. Prevalence in Cameroon, 2011: Report on the global HIV/AIDS epidemic. Geneva, Switzerland: UNAIDS, 2011.

Mata-Marin J, Gaytan-Martinez J, Grados-Chavarría H, Fuentes-Allen J, Arroyo-Anduiza C, Alfaro-Mejía A. Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study. Virology Journal. 2009;(6):181.

Mayne P. Clinical chemistry in diagnosis and treatment. 6th ed. UK: ELBS, 1994.

Piscatelli S. The effect of garlic supplementation on the pharmacokinetics of saquinavir. Clinical Infectious Disease. 2002;34(2):234-8.

Monjok E, Smesny A, Okokori I, Mgbere O, Essien E. Adherence to anti-retroviral therapy in Nigeria: an overview of research studies and implication for policy and practice in HIV/AIDS. Research and palliative care. 2010;(2):69-76.

Spengler U, Lichterfeld M, Rockstroh J. Antiretroviral drug toxicity- a challenge for the hepatologist? Journal of Hepatology. 2002;36(2):283-94.

Raúl J, Mercedes R, Fernández-Castañer A, López Ortega S, López-Vega M, Lucena M. Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists. World Journal of Gastroenterology. 2007;13(3):329-40.

Lewis, J. The rational use of potentially hepatotoxic medications in patients with underlying liver disease. Informa Healthcare. 2002;(1):159-72.

Wit F, Weverling G, Weel J, Jurriaans S, Lange J. Incidence of and risk factors for severe hepatotoxicity associated with antiretroviral combination therapy. J Infect Dis. 2002;(1):23-31.

Justice A, Wagner J, Fusco G. HIV survival: liver function tests independently predict survival. XIV International AIDS Conference, Barcelona, 2002.

David J, David M, John P, William M, Thomas E. Hepatic disease in patients with AIDS. Hepatology. 1987:7(5):925-30.

Dworkin B, Stahl R, Giardiana A, Wormser G, Weiss L, Jankowski R et al. The liver in AIDS-Emphasis on patients with intravenous drug abuse. Am J Gastroenterol. 1987:82(3):231-40.

Ogunro P, Oparinde D, Okesina A. Liver function tests in HIV-1 infected asymptomatic patients and HIV-1 AIDS patients without hepatomegaly in Lagos, Nigeria. Af J Clin Exper Microbiol. 2005:6(1):40-5.

Glasgow B, Anders K, Layfield L, Steinsapir K, Gitnick G, Lewin K. Clinical and pathologic findings of liver in AIDS. Am J Clin Path. 1985:83(5):582-5.

Ball SG. The Chemical Pathology of AIDS. Ann Clin Biochem. 1994;(31):401-9.