Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy

Authors

  • Ana Cecilia Montes Gil Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • Raquel Lorenzetti Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • Gun Bergsten Mendes Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • André Moreno Morcillo Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • Adyléia Aparecida Dalbo Contrera Toro Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • Marcos Tadeu Nolasco da Silva Faculdade de Ciências Médicas da Universidade Estadual de Campinas
  • Maria Marluce dos Santos Vilela Faculdade de Ciências Médicas da Universidade Estadual de Campinas

Keywords:

Aids, Pediatrics, Highly active antiretroviral therapy, Drug toxicity, Anti-bacterial agents

Abstract

CONTEXT AND OBJECTIVE: Adverse drug reactions are a signifi cant 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 Immunodefi ciency 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 classifi ed 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 signifi cant association between hepatotoxicity and use of sulfonamides (OR, 3.61; 95% confi dence 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 fi fth of patients experienced mild hepatotoxicity, attributed to antituberculous agents and sulfonamides. Our results suggest that ART was well tolerated.

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Author Biographies

Ana Cecilia Montes Gil, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

PhD. Pharmacist, Pharmacology Department, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

Raquel Lorenzetti, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MSc. Pharmacist, Pharmacology Department, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

Gun Bergsten Mendes, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MD, PhD. Pharmacologist. Pharmacology and Pediatric Departament, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/ Unicamp), Campinas, São Paulo, Brazil.

André Moreno Morcillo, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MD, PhD. Center for Investigation in Pediatrics and Pediatric Departament, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

Adyléia Aparecida Dalbo Contrera Toro, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MD, MSc. Center for Investigation in Pediatrics and Pediatric Departament, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

Marcos Tadeu Nolasco da Silva, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MD, PhD. Center for Investigation in Pediatrics and Pediatric Departament, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

Maria Marluce dos Santos Vilela, Faculdade de Ciências Médicas da Universidade Estadual de Campinas

MD, PhD. Center for Investigation in Pediatrics and Pediatric Departament, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp), Campinas, São Paulo, Brazil.

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Published

2007-07-07

How to Cite

1.
Gil ACM, Lorenzetti R, Mendes GB, Morcillo AM, Toro AADC, Silva MTN da, Vilela MM dos S. Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy. Sao Paulo Med J [Internet]. 2007 Jul. 7 [cited 2025 Mar. 17];125(4):205-9. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/2142

Issue

Vol. 125 No. 4 (2007)

Section

Original Article

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