Changes in serum liver enzymes level after switching from stavudine/lamivudine to zidovudine/lamivudine in NNRTIs based anti-retroviral regimens in Hawassa, Southern Ethiopia

摘要

Background: During stavudine phase-out in a resource limited countries, Zidovudine or Tenofovir is used to substitute stavudine. However, data concerning any difference in liver enzymes level after therapy change (switching) in Ethiopia is very limited. Methods: This prospective cohort study was carried out from May 2013 to July 2014 at ART clinic of Hawassa University teaching hospital. Of hundred fifty HIV-infected; immunologically stable adults receiving triple antiretroviral therapy: 120 were patients receiving stavudine based regimen with either of efavirenz or nevirapine during ART initiation (switch group); and the rest 30 patients were receiving zidovudine based regimen with either of efavirenz or nevirapine and also never switched (control group). Lamivudine is common for both groups. Levels of serum liver enzymes were determined and hepatotoxicity assessed according to World Health Organization ART guideline. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Results: Serum mean AST and ALT level in the switch group decreased significantly over the time observed (p=<0.0001 for both enzymes); however ALP level was significantly increased (p=<0.0001). Hepatotoxicity in the switch group was significantly decreased (AST grade > 1 from 35.8% to15.8%; and ALT from 20.8% to 3.3%) after 12 month of therapy change. Conclusion: Significantly a decreased hepatotoxicity was observed at the 12 month of post switch and this indicated that a substitution of stavudine to Zidovudine could have a potential to reverse hepatotoxicity. However, significantly decreased white blood cells count and abnormally increased level of ALP enzyme should require periodic monitoring and further investigations.