In this cross-sectional study, our data demonstrate a high prevalence of hepatotoxicity 21.65% (225). Among 1039 HIV infected individuals, 8.2% (85) were on NVP based regimen, 38.8% (403) were on EFV based regimen, 26.18% (272) were on PI based regimen and 9.8% (102) were on raltegravir based regimen; of which only 2.4% experienced severe hepatotoxicity (n=25). This is in contrast with the previous findings, as many previous studies conducted so far have reported high prevalence of severe hepatotoxicity. For example a study conducted by Ferdinand et al., reported grade 4 hepatotoxicity in 7.9% patients , a retrospective study conducted at Duke University Medical Center (DUMC) and Durham VA Medical Center (DVAMC) Infectious Diseases Clinics have reported 10.7% incidence of severe hepatotoxicity . However, a recent study conducted on Ethiopian cohort have reported grade 3 and grade 4 hepatotoxicity among 1.84% of HIV infected patients . The reason why the higher incidence was found among other cohort studies might be our study excluded patient with HBV/HCV infection.
Among the 225 patients, 12.31% of them were on first line ART regimen. However SH among patient on first line ART was found to be present in 1.82%, this is similar with the previous finding that, among those receiving first line ART 1.7% had SH. However many finding states that overall rate of SH was between (4.2% - 8.9%) [11-13].In addition by analyzing further we found that SH was found to be higher in NVP (19.35%) than EFV (14.4%) based NNRTI, this is in line with the previous findings. The proportion of hepatotoxicity among HIV infected individuals is found to be 3.84%, 2.21%, 0.96% for patients who are ART naïve, on PI based regimen and raltegravir based regimen respectively. A study conducted on ART naïve HIV infected African cohort reported 0.3% of SH which is consistent with our finding of 0.28% of SH among ART-naïve .
Among PI based regimen full dose RTV is found to be more hepatotoxic [8, 15-18]. Moreover many cases of hepatotoxicity are also found to be associated with Indinavir (IDV) and Saquinavir (SQV). However, Nelfinavir (NFV), Lopinavir (LPV), Atazanavir (ATV) is found to have good safety profile regarding the liver. [19-22]. In our study among patient with hepatoxicity only 2.21% were on second line PI based regimen, which is very low compared to previous studies. The reason might be, patient on second line were mostly taking LPV/r, ATV/r based PI regimens which is found to have less liver toxicity. Liver toxicity among patients taking Raltegravir based regimen was 0.96%, previously a study conducted to analyze the hepatic safety profile of Raltegravir states that severe hepatotoxicity was not found in HIV mono-infected patients taking raltegravir based regimen. Thus raltegravir based regimen has good hepatic safety profile compared to PIs and NNRTIs.
Among patients with SH, 24% changed their ART regimen for various reasons like hepatotoxicity, allergy,...