Available online on 15.08.2025 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2025 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access Full Text Article                                                                             Research Article

Prevalence of Liver Damage in Patients Under Antiretroviral Therapy at Gitwe District Hospital

Ishimwe Alain Prudence ¹*, Tharcisse Gatembezi ²_; Gratien Twagirumukiza ², Nsabiyaremye Lauben ³, Jean Claude Tuyishime ², Colette Mukamana ⁴, Rwandema Joseph ³, Philippe Hakizimana ² 

¹ Faculty of Health Sciences, Department of Biomedical Laboratory Sciences, INES Ruhengeri, Musanze, Rwanda

² Faculty of Education, department of Education sciences, University of GITWE, Rwanda

³ Faculty of Education, department of Arts and Humanities, University of GITWE, Rwanda

⁴ Faculty of Health Sciences, department of Nursing Sciences, University of GITWE, Rwanda 

 

 

INTRODUCTION

The emergence of liver diseases as one of the major causes of death in people infected with HIV has paralleled the introduction of more effective antiretroviral therapies¹. 

More than 60% of the prescribed drugs are cleared in the liver, and hepatic injury is the most frequent cause of drug discontinuation in clinical trials. Thus, it is not surprising that all ART drugs have some risk of hepatotoxicity, which varies depending on the specific characteristics of the drugs².

Measuring liver enzymes is the most common way of determining hepatotoxicity. HIV and antiretroviral medications both cause abnormalities in liver enzymes. Antiretroviral (ARV) medications harm liver cells either directly or through their active metabolites³.

Typical mechanisms of liver disease include oxidative stress, mitochondrial injury, lipotoxicity, immune-mediated injury, cytotoxicity, toxic metabolite accumulation, gut microbial translocation, systemic inflammation, senescence and nodular regenerative hyperplasia⁴. 

Patients with HIV appear to have increased risk of hypersensitivity reactions when compared with the general population, possibly predisposing them to higher likelihood of Drug induced liver injury (DILI) from medications such as trimethoprim-sulfamethoxazole and acyclovir. Additionally, drug–drug interactions seen in these patients who are typically burdened by polypharmacy may potentiate hepatotoxic effects of other agents². HIV continues to spread rapidly and Sub-Saharan Africa is the hardest-hit region in the world, with more than two-thirds of all people living with HIV globally⁵. 

 Patients on Nevirapine-containing regimens, for example, experienced liver damage and skin rashes⁶. Metabolic disorders: including excess weight, obesity and diabetes are significant causes of liver disease among people with HIV in lower and middle-income countries, while hepatitis B and C play a minimal role⁷. 

Aspartate aminotransferase (AST) is an enzyme found in several parts of the body, including: heart, brain, pancreas, liver and muscles. AST is an enzyme that helps the body break down amino acids. Like ALT, AST is usually present in blood at low levels. An increase in AST levels may mean liver damage, liver disease or muscle damage⁸.

 AST and ALT are the enzymes that are most commonly released into the bloodstream when the liver is stressed⁹. 

METHODS

Study site and target population

The study was conducted at Gitwe District Hospital, located in Ruhango District, Southern Province, Rwanda. The study population was 450 HIV patients attending Gitwe District Hospital exposed to ART. We collected the data from 2023 to 2024 using records of Gitwe District Hospital. Systematic random sampling was used to collect data of 212 patients.    HIV/AIDS patients exposed on ART and tested for liver function using (alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were included in this study.

Ethical Consideration

An official approval letter to conduct the study was provided by University of Gitwe and the permission to collect data was delivered by Research Committee of Gitwe District Hospital. We agreed to respect ethical rules and regulations.

 

RESULTS

Socio- demographic characteristics of participants

Table 1: Distribution of participants by gender

Gender	Frequency	Percent	Cumulative Percent
Male	80	37.7	37.7
Female	132	62.3	100.0
Total	212	100.0

 The table above showed the distribution of participants based on gender. Male were fewer 80 (37.7%) and female 132(62.3%).

Table 2: Distribution of participants by age 

Age	Frequency	Percent	Cumulative Percent
<40	20	9.4	9.4
40+	192	90.6	100.0
Total	212	100.0

The table above showed the distribution of patients based on age. Young patients below 40 years old were fewer 20(9.4%) than adult patients above or equal to 40 years old 192(90.6%).

Table 3: Distribution of patients by results of AST test

Level	of liver damage	Frequency	Percent	Cumulative Percent
	Normal Male <50IU/L	69	32.5	32.5
	Normal Female <35IU/L	94	44.3	76.9
	Mild and Moderate Liver damage Male (50-100)IU/L	2	0.9	77.8
	Mild and Moderate Liver damage Female (35-100)IU/L	43	20.3	98.1
	Severe 100+	4	1.9	100.0
	Total	212	100.0

The table above showed the result for liver function test 69(32.5%) were normal male, 94 (44.3%) were normal female, 2(0.9 %) males were with mild and moderate damaged liver, 43(20.3%) females were with mild and moderate damaged liver and 4(1.9%) were with severe damaged liver.

Table 4: Distribution of patients by results of ALT test and sex

Level of liver damage	Frequency	Percent	Cumulative Percent
Normal Male <60IU/L	72	34.0	34.0
Normal Female <40IU/L	116	54.7	88.7
Mild and Moderate Male (60-100)IU/L	3	1.4	90.1
Mild and Moderate Female (40-100)IU/L	17	8.0	98.1
Severe 100+	4	1.9	100.0
Total	212	100.0

The table above showed liver function test results using ALT test. Normal female and male 116(54.5%) and  72(34.0%) respectively for liver function represent major group, mild and moderate liver damage in female 17(8.0%) and male 3(1.4%) are greater than severe liver damage 4(1.9%).

 

Table 5: Prevalence of liver (mild, moderate and severe) damaged Patients

State of liver function	Frequency	Percent	Cumulative Percent
Normal liver(males and females)	188	88.68	88.68
Liver damage (mild,moderate and severe)	24	11.32	100
Total	212	100.0

The table above shows the distribution of patients based on prevalence of normal Liver function and liver damage (mild, moderate and severe) in patients: 88.68% were with normal liver function and 11.32% were with mild, moderate and severe damaged liver.

 

 

DISCUSSION

This retrospective study was conducted on HIV-positive individuals exposed to ART and tested for liver function by using AST and ALT. We found that the prevalence of liver damage was 11.32 %. This prevalence is lower and seems to be equal to that found in another study with (12.41%)¹⁰   and very low to those found in South Africa (17%), Cameroon (42.1%), Nigeria (36.4%), and Iran (32%)¹¹. However, it is higher than that of other cohort studies in Uganda (4.2%), Botswana (1.1%), Netherlands (7.9%) and Taiwan (4.9%)¹¹. The difference could be due to the differences in the prevalence of risk factors for liver disease like hepatitis B and C and other opportunistic infections and commitment of health care provider in follow-up duration and periodic monitoring of liver damage in patients. In the present study, severe hepatotoxicity was 1.9% of the all patients. This finding is consistent with other studies carried out in Uganda and Thailand that showed the prevalence of severe liver damage of 2.9 % and 1.3 % respectively¹².The decreased prevalence of severe cases of liver damage in our study (1.9%) may be brought on by efforts of Gitwe District Hospital health professional who test and change medication for patients before progression of moderate liver damage to severe liver damage. 

CONCLUSION

According to the present study, many HIV-infected people exposed to ART 188(88.68%) were with normal liver function, 24 (11.32%) were with mild, moderated and severe liver damage. Severe case of liver damage were very few. This result emphasizes the significance of regular monitoring in order to avoid severe liver damage. The findings of this study will assist policymakers and future researchers in decision-making based on evidence. 

Acknowledgement: We would like to express our gratitude to all health professional providers of Gitwe District Hospital, Ruhango District, in Rwanda for their records of epidemiological data of local HIV/AIDS.

Funding: Nil

Competing Interests: None declared.

Ethics approval: The study was approved by the University of Gitwe and Research Committee of   Gitwe District Hospital.

Conflict of Interest: Authors declare no conflict of interest on availability of raw data and material.

Author Contributions: All authors have equal contributions in the preparation of the manuscript and compilation. 

REFERENCES

1. Lucien, K. C. The effects of antiretroviral treatment on liver function enzymes among HIV-infected out patients attending the central hospital of Yaounde, Cameroon. African Journal of Clinical and Experimental Microbiology,2010; 11(3). https://doi.org/10.4314/ajcem.v11i3.57777

2. Abarca, J. C. Antiretroviral therapies for human immunodeficiency virus and liver disease: challenges and opportunities. Annals of Hepatology. Annals of Hepatology,2020; 121-122. https://doi.org/10.1016/j.aohep.2020.02.004 PMid:32138869

3. Chwiki, S. C.-A. Adverse effects of antiretroviral therapy on liver hepatocytes and endothelium in HIV patients: an ultrastructural perspective. Ultrastructural pathology,2017; 41(2), 186-195. https://doi.org/10.1080/01913123.2017.1282066 PMid:28277148 PMCid:PMC6077994

4. Kaspar, M. B. Mechanisms of liver disease in patients infected with HIV. BMJ open gastroenterology,2017; 000166. https://doi.org/10.1136/bmjgast-2017-000166 PMid:29119002 PMCid:PMC5663263

5. Anyanwu, C. F. Substance Use, Highly Active Antiretroviral Therapy, and Liver Enzymes: Evidence From a Cross-Sectional Study of HIV-Infected Adult . Frontiers in Reproductive Health,2021;664080. https://doi.org/10.3389/frph.2021.664080 PMid:36303994 PMCid:PMC9580740

6. Biały, M. C. Impact of Combination Antiretroviral Treatment on Liver Metabolic Health in HIV-Infected Persons. Viruses,2023; 2432. https://doi.org/10.3390/v15122432 PMid:38140673 PMCid:PMC10747352

7. Goodrich, N. R. Alcoholic Liver Disease in People with Hiv in Low-and Middle-Income Countries: Prevalence and Factors Associated with Severity of Hepatic Fibrosis. In The Liver Meeting 2023, S1575-S1576.

8. Chopra, S. &. The American journal of medicine,. Laboratory tests and diagnostic procedures in evaluation of liver disease,1985; 221-230. https://doi.org/10.1016/0002-9343(85)90013-0 PMid:2411132

9. Thapa, B. R. Liver function tests and their interpretation. The Indian Journal of Pediatrics,2007; 663-671. https://doi.org/10.1007/s12098-007-0118-7 PMid:17699976

10. Qin, F. J. Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China . BMJ open,2019; 9(4), e023140. https://doi.org/10.1136/bmjopen-2018-023140 PMid:30944128 PMCid:PMC6500098

11. Mohammed, O. A. (2022). Prevalence of hepatotoxicity among HIV-infected patients in Ethiopia: a systematic review and meta-analysis. BMC Infectious Diseases, 826. https://doi.org/10.1186/s12879-022-07838-w PMid:36352398 PMCid:PMC9647905

12. Mulu, W. G. Hepatotoxicity and associated risk factors in HIV-infected patients receiving antiretroviral therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. Ethiopian journal of health science,2013; 23(3), 217-226. https://doi.org/10.4314/ejhs.v23i3.4