Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia

Demissie Assegu Fenta; Agete Tadewos Hirigo

doi:doi:10.11648/j.ajhr.20140206.23

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Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia

Demissie Assegu Fenta, Agete Tadewos Hirigo

Published in American Journal of Health Research (Volume 2, Issue 6)

Received: 29 November 2014 Accepted: 11 December 2014 Published: 18 December 2014

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Abstract

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.

Published in	American Journal of Health Research (Volume 2, Issue 6)
DOI	10.11648/j.ajhr.20140206.23
Page(s)	397-403
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Hepatotoxicity, HAART Switching, HIV/AIDS, Hawassa, Ethiopia

References

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APA Style

Demissie Assegu Fenta, Agete Tadewos Hirigo. (2014). Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. American Journal of Health Research, 2(6), 397-403. https://doi.org/10.11648/j.ajhr.20140206.23

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ACS Style

Demissie Assegu Fenta; Agete Tadewos Hirigo. Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. Am. J. Health Res. 2014, 2(6), 397-403. doi: 10.11648/j.ajhr.20140206.23

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AMA Style

Demissie Assegu Fenta, Agete Tadewos Hirigo. Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. Am J Health Res. 2014;2(6):397-403. doi: 10.11648/j.ajhr.20140206.23

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@article{10.11648/j.ajhr.20140206.23,
  author = {Demissie Assegu Fenta and Agete Tadewos Hirigo},
  title = {Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia},
  journal = {American Journal of Health Research},
  volume = {2},
  number = {6},
  pages = {397-403},
  doi = {10.11648/j.ajhr.20140206.23},
  url = {https://doi.org/10.11648/j.ajhr.20140206.23},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20140206.23},
  abstract = {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= 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.},
 year = {2014}
}

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TY  - JOUR
T1  - Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia
AU  - Demissie Assegu Fenta
AU  - Agete Tadewos Hirigo
Y1  - 2014/12/18
PY  - 2014
N1  - https://doi.org/10.11648/j.ajhr.20140206.23
DO  - 10.11648/j.ajhr.20140206.23
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 397
EP  - 403
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20140206.23
AB  - 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= 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.
VL  - 2
IS  - 6
ER  -

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Author Information

Demissie Assegu Fenta

Hawassa University College of Medicine and Health Science Teaching Hospital, Hawassa, Southern Ethiopia
Agete Tadewos Hirigo

Hawassa University College of Medicine and Health Science Teaching Hospital, Hawassa, Southern Ethiopia

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Demissie Assegu Fenta, Agete Tadewos Hirigo. (2014). Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. American Journal of Health Research, 2(6), 397-403. https://doi.org/10.11648/j.ajhr.20140206.23

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ACS Style

Demissie Assegu Fenta; Agete Tadewos Hirigo. Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. Am. J. Health Res. 2014, 2(6), 397-403. doi: 10.11648/j.ajhr.20140206.23

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AMA Style

Demissie Assegu Fenta, Agete Tadewos Hirigo. Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia. Am J Health Res. 2014;2(6):397-403. doi: 10.11648/j.ajhr.20140206.23

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@article{10.11648/j.ajhr.20140206.23,
  author = {Demissie Assegu Fenta and Agete Tadewos Hirigo},
  title = {Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia},
  journal = {American Journal of Health Research},
  volume = {2},
  number = {6},
  pages = {397-403},
  doi = {10.11648/j.ajhr.20140206.23},
  url = {https://doi.org/10.11648/j.ajhr.20140206.23},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20140206.23},
  abstract = {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= 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.},
 year = {2014}
}

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TY  - JOUR
T1  - Changes in Serum Liver Enzymes Level after Switching from Stavudine/Lamivudine to Zidovudine/Lamivudine in NNRTIs Based Anti-Retroviral Regimens in Hawassa, Southern Ethiopia
AU  - Demissie Assegu Fenta
AU  - Agete Tadewos Hirigo
Y1  - 2014/12/18
PY  - 2014
N1  - https://doi.org/10.11648/j.ajhr.20140206.23
DO  - 10.11648/j.ajhr.20140206.23
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 397
EP  - 403
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20140206.23
AB  - 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= 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.
VL  - 2
IS  - 6
ER  -

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