Increased hepatotoxicity among HIV-infected adults co-infected with <i>Schistosoma mansoni</i> in Tanzania: A cross-sectional study

<div><p>Introduction</p><p>Little is known about hepatotoxicity in patients with schistosome and HIV co-infections. Several studies have reported increased liver enzymes and bilirubin levels associated with schistosome infection. We investigated whether HIV-infected adults on antiretroviral therapy who had <i>S</i>. <i>mansoni</i> co-infection had a higher prevalence of hepatotoxicity than those without.</p><p>Methodology/Principal findings</p><p>We determined the presence and grade of hepatotoxicity among 305 HIV-infected outpatients who had been on medium-term (3–6 months) and long-term (>36 months) antiretroviral therapy in a region of northwest Tanzania where <i>S</i>. <i>mansoni</i> is hyperendemic. We used the AIDS Clinical Trial Group definition to define mild to moderate hepatotoxicity as alanine aminotransferase, alanine aminotransferase, and/or bilirubin elevations of grade 1 or 2, and severe hepatotoxicity as any elevation of grade 3 or 4. We determined schistosome infection status using the serum circulating cathodic antigen rapid test and used logistic regression to determine factors associated with hepatotoxicity. The prevalence of mild-moderate and severe hepatotoxicity was 29.6% (45/152) and 2.0% (3/152) in patients on medium-term antiretroviral therapy and 19.6% (30/153) and 3.3% (5/153) in the patients on long-term antiretroviral therapy. <i>S</i>. <i>mansoni</i> infection was significantly associated with hepatotoxicity on univariable analysis and after controlling for other factors associated with hepatotoxicity including hepatitis B or C and anti-tuberculosis medication use (adjusted odds ratio = 3.0 [1.6–5.8], p = 0.001).</p><p>Conclusions/Significance</p><p>Our work demonstrates a strong association between <i>S</i>. <i>mansoni</i> infection and hepatotoxicity among HIV-infected patients on antiretroviral therapy. Our study highlights the importance of schistosome screening and treatment for patients starting antiretroviral therapy in schistosome-endemic settings. Additional studies to determine the effects of schistosome-HIV co-infections are warranted.</p></div

Factors associated with hepatotoxicity in patients on ART in Tanzania.

<p>Factors associated with hepatotoxicity in patients on ART in Tanzania.</p

Baseline characteristics of 305 HIV-infected, Tanzanian adults on antiretroviral therapy (ART) at Bugando Medical Centre and comparison between patients on ART 3–6 months (GROUP 1) or >36 months (GROUP 2).

<p>Baseline characteristics of 305 HIV-infected, Tanzanian adults on antiretroviral therapy (ART) at Bugando Medical Centre and comparison between patients on ART 3–6 months (GROUP 1) or >36 months (GROUP 2).</p