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Increased hepatotoxicity among HIV-infected adults co-infected with Schistosoma mansoni in Tanzania: A cross-sectional study.

Abstract 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 S. mansoni co-infection had a higher prevalence of hepatotoxicity than those without.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 28817570
OWN - NLM
STAT- MEDLINE
DA  - 20170817
DCOM- 20170901
LR  - 20170901
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 8
DP  - 2017 Aug
TI  - Increased hepatotoxicity among HIV-infected adults co-infected with Schistosoma
      mansoni in Tanzania: A cross-sectional study.
PG  - e0005867
LID - 10.1371/journal.pntd.0005867 [doi]
AB  - INTRODUCTION: 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 S. mansoni co-infection had
      a higher prevalence of hepatotoxicity than those without. METHODOLOGY/PRINCIPAL
      FINDINGS: 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 S.
      mansoni 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. S. mansoni
      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). CONCLUSIONS/SIGNIFICANCE: Our work
      demonstrates a strong association between S. mansoni 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.
FAU - Marti, Amon I
AU  - Marti AI
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Colombe, Soledad
AU  - Colombe S
AUID- ORCID: http://orcid.org/0000-0003-0300-902X
AD  - Center for Global Health, Department of Medicine, Weill Cornell Medicine, New
      York, New York, United States of America.
FAU - Masikini, Peter J
AU  - Masikini PJ
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Kalluvya, Samuel E
AU  - Kalluvya SE
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Smart, Luke R
AU  - Smart LR
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Wajanga, Bahati M
AU  - Wajanga BM
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Jaka, Hyasinta
AU  - Jaka H
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
FAU - Peck, Robert N
AU  - Peck RN
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
AD  - Center for Global Health, Department of Medicine, Weill Cornell Medicine, New
      York, New York, United States of America.
FAU - Downs, Jennifer A
AU  - Downs JA
AD  - Catholic University of Health and Allied Sciences and Bugando Medical Centre,
      Mwanza, Tanzania.
AD  - Center for Global Health, Department of Medicine, Weill Cornell Medicine, New
      York, New York, United States of America.
LA  - eng
PT  - Journal Article
DEP - 20170817
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
RN  - 0 (Anti-Retroviral Agents)
RN  - EC 2.6.1.2 (Alanine Transaminase)
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Adult
MH  - Alanine Transaminase/blood
MH  - Anti-Retroviral Agents/*adverse effects/therapeutic use
MH  - Bilirubin/blood
MH  - Coinfection/*complications
MH  - Cross-Sectional Studies
MH  - HIV Infections/*complications/*drug therapy
MH  - Humans
MH  - Liver Failure/*chemically induced/*epidemiology
MH  - Outpatients
MH  - Prevalence
MH  - Schistosomiasis mansoni/*complications
MH  - Tanzania
EDAT- 2017/08/18 06:00
MHDA- 2017/09/02 06:00
CRDT- 2017/08/18 06:00
PHST- 2017/05/02 [received]
PHST- 2017/08/10 [accepted]
PHST- 2017/08/29 [revised]
AID - 10.1371/journal.pntd.0005867 [doi]
AID - PNTD-D-17-00618 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2017 Aug 17;11(8):e0005867. doi:
      10.1371/journal.pntd.0005867. eCollection 2017 Aug.