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Darge T, Babusha A, Chilo D, Dukessa A, Teferi S. Predictors of severe hepatotoxicity among retroviral infected adults on HAART regimen in Ilubabor Zone, Southwest Ethiopia. Sci Rep 2024; 14:8473. [PMID: 38605149 PMCID: PMC11009247 DOI: 10.1038/s41598-024-57900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
Nearly half of the deaths among hospitalized human immuno deficiency virus-infected patients in the highly active antiretroviral therapy era have been attributed to liver disease. This may range from an asymptomatic mild increase of liver enzymes to cirrhosis and liver failure. Different works of literature elucidated both retroviral infection and the adverse effects of highly active antiretroviral therapy as a cause of hepatotoxicity. Individual adaptations to medications and environmental exposures, shaped by cultural norms and genetic predispositions, could potentially modulate the risk and progression of liver disease in this population. Therefore, this study aims to assess the predictors of severe hepatotoxicity in retroviral-infected adults receiving highly active antiretroviral therapy regimens within the Ilubabor Zone, Southwest Ethiopia. A facility-based cross-sectional study was conducted among adult retroviral-infected patients in five selected anti-retro virus therapy clinics from May1 to July 30/2022. A systematic sampling technique was used to select 457 study participants and Binary logistic regression statistical data analysis was used, P value < 0.05 was considered statistically significant. The prevalence of severe hepatotoxicity was 21.44% in the study population. CD+4 count < 200 cells/mm3 (AOR = 2.19, 95% CI 1.04-5.22, P = 0.01), human immunodeficiency virus co-infection with tuberculosis (AOR = 2.82, 95% CI 1.01-8.29, P = 0.03) and human immuno deficiency virus co-infection with hepatitis-B/hepatitis C virus (AOR = 5.02, 95% CI 1.82-16.41) were predictors of severe hepatotoxicity. The magnitude of severe hepatotoxicity was high among adult retroviral-infected patients on highly active anti-retroviral drug regimens. Co-infection of human immuno deficiency virus with hepatitis B virus or hepatitis C virus, tuberculosis and CD4+T-cell count below 200 cells/mm3 were predictors of severe hepatotoxicity. Therefore, HIV patients on highly active antiretroviral therapy require close attention and regular monitoring of their liver function.
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Affiliation(s)
- Tefera Darge
- Department of Biomedical Sciences, College of Health Sciences, Mettu University, Mettu, Ethiopia.
| | - Alemayehu Babusha
- Department of Biomedical Sciences, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Dessalegn Chilo
- Department of Pharmacy, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Abebe Dukessa
- Department of Biomedical Sciences, Institution of Health, Jimma University, Jimma, Ethiopia
| | - Sisay Teferi
- Department of Medical Laboratory Science, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Anyanwu CF, JohnBull TO, Usman IM, Aigbogun EO, Ochai J, Qasem AH, Alkhayyat SS, Alexiou A, Batiha GES. Substance Use, Highly Active Antiretroviral Therapy, and Liver Enzymes: Evidence From a Cross-Sectional Study of HIV-Infected Adult Patients Without Comorbidities on HAART in the University of Port Harcourt Teaching Hospital. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:664080. [PMID: 36303994 PMCID: PMC9580740 DOI: 10.3389/frph.2021.664080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
This study applied a structural equation modeling (SEM) to evaluate the role of substance use (alcohol, smoking, and trado-medicine use) to changes in the liver enzymes (AST, ALT, and ALP) levels in HIV-infected adult patients on a highly active antiretroviral treatment (HAART) for not <1 year. The study was a cross-sectional, part of a randomized comparative trial (Ref: UPH/CEREMAD/REC/19), involving 129 (46 males and 83 females) HIV-infected adult patients. Liver enzyme levels were determined from analyzed blood samples using the Clinical Chemistry Analyser (VS10) manufactured by Vitro Scient, while the study determined substance use using a reliable (Cronbach alpha = 0.805) rapid-exploratory survey questionnaire. Liver enzyme values were further categorized into: normal or abnormal using normal reference ranges (ALT = 7–55 U/L, AST = 8–48 U/L, and ALP = 40–129 U/L). STATGRAPHICS V16.1.11 (StatPoint Tech., Inc.) and SPSS (IBM® Amos V21.0.0, USA) were used to analyze the data. Among the HIV-HAART patients, 27.9% were alcohol users, 20.9% smokers, and 20.1% trado-medicine users. In addition, ALP (71.3%) abnormality was higher than ALT (34.9%) and AST (28.7%). The result from the SEM provided only a partial support for our hypotheses of direct substance use effects on the liver enzyme levels and abnormalities; with a direct association of alcohol with an elevated AST (b = 0.170, p = 0.05) and smoking with a higher AST (b = 0.484, p < 0.01) and ALT (b = 0.423, p < 0.01) values. Trado-medicine use was not directly associated with enzyme elevation and abnormality. In conclusion, ALP abnormality was the most common, and there is a close association between an elevated ALT and AST, with or without an elevated ALP. The study found that HIV-HAART patients who drink or smoke will have at least one or more abnormal transaminases. The possible explanation to the increased risk among HIV-HAART patients could be associated with the metabolic pressures and supra-additive effects on the livers.
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Affiliation(s)
- Chinwe F. Anyanwu
- Department of Pharmacology, Faculty of Basic Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria
| | - Tamuno-Olobo JohnBull
- Department of Human Anatomy, Faculty of Basic Medical Sciences, Niger Delta University, Amassoma, Nigeria
- *Correspondence: Eric O. Aigbogun Jr.
| | - Ibe M. Usman
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Kampala, Uganda
| | - Eric O. Aigbogun
- Department of Public Health Science, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
- Tamuno-Olobo JohnBull
| | - Joy Ochai
- Human Anatomy Department, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Ahmed H. Qasem
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Shadi S. Alkhayyat
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Athanasios Alexiou
- Novel Global Community Educational Foundation, Hebersham, NSW, Australia
- AFNP Med Austria, Wien, Austria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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Freiman JM, Fatch R, Cheng D, Emenyonu N, Ngabirano C, Geadas C, Adong J, Muyindike WR, Linas BP, Jacobson KR, Hahn JA. Prevalence of elevated liver transaminases and their relationship with alcohol use in people living with HIV on anti-retroviral therapy in Uganda. PLoS One 2021; 16:e0250368. [PMID: 34061870 PMCID: PMC8168875 DOI: 10.1371/journal.pone.0250368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Isoniazid preventive therapy (IPT) reduces tuberculosis reactivation and mortality among persons living with HIV (PLWH), yet hepatotoxicity concerns exclude "regular and heavy alcohol drinkers" from IPT. We aimed to determine the prevalence of elevated liver transaminases among PLWH on antiretroviral therapy (ART) who engage in alcohol use. SETTING The Immune Suppression Syndrome Clinic of Mbarara, Uganda. METHODS We defined elevated liver transaminases as ≥1.25 times (X) the upper limit of normal (ULN) for alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST). We evaluated the associations of current alcohol use and other variables of interest (sex, body mass index, and ART regimen) with elevated transaminases at study screening, using multivariable logistic regression to obtain adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS Among 1301 participants (53% female, median age 39 years, 67.4% current alcohol use), 18.8% (95% CI: 16.8-21.1) had elevated transaminases pre-IPT, with few (1.1%) severe (≥5X the ULN). The proportion with any elevation among those currently using alcohol and those abstaining was 22.3% and 11.6%, respectively (p<0.01). In multivariable analyses, those currently using alcohol had higher odds of elevated transaminases compared to those abstaining (aOR 1.65, 95% CI 1.15-2.37) as did males compared to females (aOR 2.68, 95% CI 1.90-3.78). CONCLUSIONS Pre-IPT elevated transaminases among PLWH receiving ART were common, similar to prior estimates, but severe elevations were rare. Current drinking and male sex were independently associated with elevated transaminases. Further research is needed to determine the implications of such transaminase elevations and alcohol use on providing IPT.
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Affiliation(s)
- J. Morgan Freiman
- Department of Medicine and Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States of America
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Debbie Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Christine Ngabirano
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolina Geadas
- Department of Medicine and Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States of America
| | - Julian Adong
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie R. Muyindike
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Benjamin P. Linas
- Department of Medicine and Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States of America
| | - Karen R. Jacobson
- Department of Medicine and Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States of America
| | - Judith A. Hahn
- Department of Medicine, University of California, San Francisco, CA, United States of America
- Department of Epidemiology, University of California, San Francisco, San Francisco, CA, United States of America
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Mekuriaw B, Belayneh Z, Molla A, Mehare T. Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. Harm Reduct J 2021; 18:55. [PMID: 34001138 PMCID: PMC8130112 DOI: 10.1186/s12954-021-00503-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Alcohol use is a common practice of almost all communities worldwide and it is more common among persons with HIV infection. Alcohol consumption among people with HIV/AIDS may result in poor treatment adherence, further immunity suppression and increase the risk of comorbid illness (diseases) which collectively diminish the anti-retroviral therapy responses. Although there are separate studies conducted regarding alcohol use among people with HIV/AIDS in Ethiopia, the finding results are highly variable and inconsistent. Therefore, conducting a systematic review and meta-analysis has a paramount importance to show the pooled prevalence of alcohol use and to identify its determinants among people with HIV/AIDS. Methods A systematic search of electronic databases of PubMed/Medline, Science Direct, Hinnari and Cochrane library was employed. Additionally, the grey literature was searched from Google and Google Scholar. Data were extracted using a standardized data extraction format prepared in Microsoft Excel . STATA-version 14 statistical software was used for analysis. Heterogeneity of primary studies was found as evaluated using the I2 test result. As a result, a random-effect meta-analysis model was used to estimate the pooled prevalence of alcohol use. Results A total of 22 primary studies which comprises 8,368 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime, current and hazardous alcohol use among HIV patients in Ethiopia were 36.42% [95% CI (19.96, 52.89)], 19.00% [95% CI (12.98, 25.01)] and 21.64% [95% CI (12.72, 30.55)], respectively. Khat chewing [OR = 3.53, (95% CI 1.31, 9.51)] and cigarette smoking [OR = 7.04, (95% CI 3.53, 14.04)] were found as statistically significant determinants of hazardous alcohol use among people with HIV infection. Conclusions The result of this review showed that alcohol drinking is highly practiced among people with HIV/AIDS in Ethiopia. The magnitude of alcohol use was highly variable based on the screening methods used to measure alcohol use. Comorbid substance use (khat and cigarette) increases the risk of alcohol consumption among HIV patients. This suggests a need for designing appropriate and culturally applicable intervention programs and policy responses. Trial registration PROSPERO 2019, “CRD42019132524.” Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00503-6.
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Affiliation(s)
- Birhanie Mekuriaw
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
| | - Zelalem Belayneh
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Alemayehu Molla
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Tsegaye Mehare
- Department of Biomedical Science, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
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Deress T, Million Y, Belachew T, Jemal M, Girma M. Seroprevalence of Hepatitis C Viral Infection in Ethiopia: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2021; 2021:8873389. [PMID: 33897305 PMCID: PMC8052182 DOI: 10.1155/2021/8873389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/13/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C virus is a highly genetically heterogenous bloodborne pathogen that is responsible for acute and chronic hepatitis. Globally, an estimated 71 million population is chronically infected with this virus from which 399,000 people die every year. Its prevalence is high in Ethiopia and varies from region to region, even among different studies within a region. METHODS Electronic databases, including Science Direct, Medline, HINARI, African Journals Online, TRIP database, African Index Medicus, and Directory of Open Access Journals, searched from 2010 to 2020 and published articles were included. Due to evidence of considerable heterogeneity, the pooled prevalence of anti-HCV was analyzed using the random-effects model. The possible sources of heterogeneity were analyzed through subgroup analysis, sensitivity analysis, and meta-regression. Funnel plots and Egger's test statistics were used to determine the presence of publication bias. RESULTS The analysis of 56 articles showed that the prevalence of anti-HCV in Ethiopia ranged from 0% to 22%. The pooled prevalence estimated was 2% (95% CI 2.0-3.0), and the meta-regression statistics indicated that the diagnostic method (p=0.037), study group (p=0.005), and level of bias (p=0.035) showed statistically significant association with the outcome variable. The sensitivity analysis claims no influence on the overall effect estimate while removing a single study from the analysis at a time. Egger's test statistics (p ≤ 0.001) declare the presence of publication bias that is handled using time and fill analysis. CONCLUSIONS The pooled prevalence of anti-HCV in Ethiopia was high. Predictor variables, including the diagnostic method, study group, and level of bias, showed a statistically significant relationship with the outcome variable. Strengthening the scope of existing prevention and control programs and implementing novel approaches, including screen-and-treat, could significantly help to tackle this critical public health issue. The study provides a current estimate which is valuable for policymakers and other responsible bodies.
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Affiliation(s)
- Teshiwal Deress
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yihenew Million
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Teshome Belachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohabaw Jemal
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Girma
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hepatitis C Virus Infection among HIV-Infected Patients Attending Dessie Referral Hospital, Northeastern Ethiopia. Int J Microbiol 2021; 2021:6675851. [PMID: 33552160 PMCID: PMC7846398 DOI: 10.1155/2021/6675851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 12/09/2022] Open
Abstract
Objective Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) coinfection increases the incidence of end-stage liver disease which is more severe in immune-compromised HIV-infected patients than HCV infection alone. The aim of this study was to assess HCV infection and the associated risk factors among HIV/AIDS patients attending Dessie Referral Hospital, Northeastern Ethiopia. Methods A hospital-based cross-sectional study was conducted among 249 HIV-infected adults selected by a systematic random sampling technique from January to March 2018. A structured questionnaire was used to collect sociodemographic and risk factor data. Moreover, the blood specimen was collected and tested for CD4 count and anti-HCV antibody detection according to standard operating procedures. The data obtained were entered into SPSS version 20, and descriptive statistics, bivariate and multivariate logistic regression analyses were performed. A P value ≤0.05 with a corresponding 95% confidence interval was considered as statistically significant. Result Of a total of 249 HIV-infected study subjects, 120 (48.2%) were male and 129 (51.8%) were females, while the mean (±SD) age and CD4+ cells/mm3 were 39.10 (±11.507) years and 316.08 + 290.607 cells/mm3, respectively. Anti-HCV antibody was detected in 13 (5.2%) patients with higher prevalence rate found in males (P=0.078) and elders >50 years of age (P=0.013) than their counterparts. Age group of >50 years of age (AOR = 9.070, 95% CI: 1.578, 52.117, P=0.013), longer duration of HIV treatment (AOR = 5.490, 95% CI: 1.341, 34.458, P=0.041), WHO clinical stage III/IV (AOR = 12.768, 95% CI: 2.293, 71.106, P=0.004), previous history of hospitalization (AOR = 10.234, 95% CI: 2.049, 51.118, P=0.005), tooth extraction (AOR = 6.016, 95% CI: 1.137, 36.837, P=0.048), and liver disease (AOR = 11.398, 95% CI: 1.275, 101.930, P=0.029) were statistically significant predictors of HCV infection. Conclusion The prevalence of HCV infection is still higher and causes concern. Therefore, screening of these high-risk groups should be critical to reduce mortality and to improve clinical outcomes.
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Moed S, Zaman MH. Towards better diagnostic tools for liver injury in low-income and middle-income countries. BMJ Glob Health 2019; 4:e001704. [PMID: 31406595 PMCID: PMC6666799 DOI: 10.1136/bmjgh-2019-001704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/10/2019] [Accepted: 06/15/2019] [Indexed: 01/01/2023] Open
Abstract
Liver disease is a significant public health burden in both high-income and low-income countries, accounting for over 2 million annual, global deaths. Despite the significant mortality burden, liver diseases are historically a neglected problem due to a lack of accurate incidence and prevalence statistics, as well as national and international programmes targeting these diseases. A large portion of deaths due to liver diseases can be treated (eg, chronic hepatitis B), cured (eg, chronic hepatitis C) or prevented (eg, acute liver failure due to medications) if prompt diagnosis is made, but currently diagnostic methods fall short. Therefore, there is a critical need to fund the development of prompt, effective diagnostics for liver function, specifically in low-income and middle-income countries where the landscape for this testing is sparse. Here, we review and compare available and currently emerging diagnostic methods for liver injury in low-income and middle-income settings, while highlighting the opportunities and challenges that exist in the field.
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Affiliation(s)
- Saundria Moed
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Muhammad H Zaman
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Howard Hughes Medical Institute, Boston University, Boston, Massachusetts, USA
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Belyhun Y, Maier M, Mulu A, Diro E, Liebert UG. Hepatitis viruses in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:761. [PMID: 27993129 PMCID: PMC5168848 DOI: 10.1186/s12879-016-2090-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/03/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The existing seroepidemiological data on viral hepatitis in Ethiopia showed a wide variation in prevalence pattern and the clinical and public health burden have been underestimated. The aim of this systematic review and meta-analysis was to provide a clear and comprehensive estimation of viral hepatitis epidemiology and the potential clinical burdens in Ethiopia. METHODS A comprehensive literature search was carried out from five decades (1968-2015) published studies from biomedical databases; PubMed, Google scholar, Medline and Web of Science. RESULTS The overall pooled prevalence of hepatitis B virus (HBV) was 7.4% (95%CI: 6.5-8.4). The pooled prevalence among subgroups showed 5.2% (95%CI: 3.7-7.4) in human immunodeficiency virus (HIV) infected individuals, 8.0% (95%CI: 5.9-10.7) in community based studies, 8.4% (95%CI: 5.4-12.7) in blood donors, 11.0% (95%CI: 7.5-15.9) in immigrants and 6.9% (95%CI: 5.6-8.5) in other groups. Among study parameters considered during meta-regression analysis, only study years were associated with a decreasing HBV prevalence rate over time. The overall pooled prevalence of anti-hepatitis C virus antibody (anti-HCV) was 3.1% (95%CI: 2.2-4.4). Unlike HBV, the anti-HCV prevalence in HIV infected individuals was higher (5.5%, 95%CI: 3.8-7.8%, p = 0.01) than the prevalence observed in the other subgroup of study population. Although relatively few data were available, hepatitis virus A (HAV), D (HDV) and E (HEV) were also circulated in Ethiopia. CONCLUSIONS This review indicates that all types of viral hepatitis origins are endemic in Ethiopia. Adapting a recommended diagnostic and treatment algorithm of viral hepatitis in the routine healthcare systems and implementing prevention and control policies in the general population needs an urgent attention.
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Affiliation(s)
- Yeshambel Belyhun
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melanie Maier
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Andargachew Mulu
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Uwe Gerd Liebert
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Mulu W, Zenebe Y, Abera B, Yimer M, Hailu T. Prevalence of human immunodeficiency virus and hepatitis B virus infections in young women seeking abortion care in Ethiopia: a cross - sectional study. BMC Public Health 2016; 16:996. [PMID: 27645509 PMCID: PMC5029086 DOI: 10.1186/s12889-016-3658-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Young women aged 15-24 years are members of key populations at higher risk for Human Immunodeficiency Virus (HIV) acquisition through sexual intercourse. In areas where unprotected sex is a common practice, Hepatitis B virus (HBV) commonly transmitted via sexual and parenteral routes. The study aimed at determining HIV and HBV infections prevalence in young women attending health institutions for abortion care in Bahir Dar city, Ethiopia. METHODS A cross - sectional study was conducted from January 2015 to June 2015. Convenient sampling technique was used. Demographic and explanatory variables were collected using a structured questionnaire via face to face interview. The presence of antibody to HIV infection was detected using national HIV diagnostic test algorithm. Hepatitis B surface antigen (HBsAg) was detected using ELISA. Data were analyzed using descriptive, fisher's exact and independent sample T test as appropriate. RESULTS A total of 360 young women aged 15-24 years participated in the study. The median age of the women was 22 years. Overall, 16 (4.4 %) (95 % CI: 2.7-7.1 %) women were positive for either HBV or HIV infections. The prevalence of HIV and HBV infections were 9 (2.5 %) (95 % CI: 1.3-4.7 %) and 7 (1.94 %) (95 % CI: 0.95-4.0 %), respectively. The mean age of first sexual intercourse was 17.6 and 19.3 in HIV and HBV infected women, respectively. The prevalence of HIV infection was significantly associated with lower educational status (P < 0.001), divorced marital status (P = 0.009) and ever had symptom of other sexually transmitted infections (P = 0.001). The proportion of HBV was higher in women aged 15-17 years (P = 0.02). CONCLUSION Though there were no co-infections, HIV and HBV infections are major health problems in young women seeking abortion care. Therefore, appropriate prevention, treatment and care services must be reached to these higher risk populations.
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Affiliation(s)
- Wondemagegn Mulu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Yohannes Zenebe
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bayeh Abera
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Yimer
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadesse Hailu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Goldberg DS, Forde KA, Carbonari DM, Lewis JD, Leidl KBF, Reddy KR, Haynes K, Roy J, Sha D, Marks AR, Schneider JL, Strom BL, Corley DA, Lo Re V. Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system. Gastroenterology 2015; 148:1353-61.e3. [PMID: 25733099 PMCID: PMC4446162 DOI: 10.1053/j.gastro.2015.02.050] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Medications are a major cause of acute liver failure (ALF) in the United States, but no population-based studies have evaluated the incidence of ALF from drug-induced liver injury. We aimed to determine the incidence and outcomes of drug-induced ALF in an integrated health care system that approximates a population-based cohort. METHODS We performed a retrospective cohort study using data from the Kaiser Permanente Northern California (KPNC) health care system between January 1, 2004, and December 31, 2010. We included all KPNC members age 18 years and older with 6 months or more of membership and hospitalization for potential ALF. The primary outcome was drug-induced ALF (defined as coagulopathy and hepatic encephalopathy without underlying chronic liver disease), determined by hepatologists who reviewed medical records of all KPNC members with inpatient diagnostic and laboratory criteria suggesting potential ALF. RESULTS Among 5,484,224 KPNC members between 2004 and 2010, 669 had inpatient diagnostic and laboratory criteria indicating potential ALF. After medical record review, 62 (9.3%) were categorized as having definite or possible ALF, and 32 (51.6%) had a drug-induced etiology (27 definite, 5 possible). Acetaminophen was implicated in 18 events (56.3%), dietary/herbal supplements in 6 events (18.8%), antimicrobials in 2 events (6.3%), and miscellaneous medications in 6 events (18.8%). One patient with acetaminophen-induced ALF died (5.6%; 0.06 events/1,000,000 person-years) compared with 3 patients with non-acetaminophen-induced ALF (21.4%; 0.18/1,000,000 person-years). Overall, 6 patients (18.8%) underwent liver transplantation, and 22 patients (68.8%) were discharged without transplantation. The incidence rates of any definite drug-induced ALF and acetaminophen-induced ALF were 1.61 events/1,000,000 person-years (95% confidence interval, 1.06-2.35) and 1.02 events/1,000,000 person-years (95% confidence interval, 0.59-1.63), respectively. CONCLUSIONS Drug-induced ALF is uncommon, but over-the-counter products and dietary/herbal supplements are its most common causes.
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Affiliation(s)
- David S Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kimberly A Forde
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dena M Carbonari
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly B F Leidl
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - K Rajender Reddy
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; HealthCore, Inc, Wilmington, Delaware
| | - Jason Roy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daohang Sha
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy R Marks
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jennifer L Schneider
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Rutgers Biomedical and Health Sciences, Newark, New Jersey
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abera B, Zenebe Y, Mulu W, Kibret M, Kahsu G. Seroprevalence of hepatitis B and C viruses and risk factors in HIV infected children at the Felgehiwot referral hospital, Ethiopia. BMC Res Notes 2014; 7:838. [PMID: 25421947 PMCID: PMC4255438 DOI: 10.1186/1756-0500-7-838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/18/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Liver hepatitis due to Hepatitis B (HBV) and hepatitis C virus (HCV) co-infection is the leading cause of morbidity and mortality in HIV infected children and it is more severe in resource poor settings. Data on seroprevalence of HBV and HCV among HIV infected children are scarce in Ethiopia. This study was conducted to determine seroprevalence and risk factors of HBV and HCV and its effect on liver enzyme among HIV-positive children aged 18 months to 15 years attending the paediatric HIV care and treatment clinic at Felege Hiwot referral hospital, Ethiopia. METHODS A cross-sectional study was conducted in May, 2014. Demographic and risk factors were collected using a structured questionnaire. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies were detected using an enzyme linked immunosorbent assay (ELISA). Alanine aminotransferase (ALT) levels were determined. The results were analyzed using descriptive and logistic regression. RESULTS A total of 253 HIV positive children, boys (52.5%) and girls (47.5%) took part in the study. The median age of the children was 11 years. Overall, 19 (7.5%) of HIV infected children were positive either for HBsAg or anti-HCV antibodies. The seroprevalence of HBV and HCV were 2.0% and 5.5%, respectively. All HBsAg positive children were in older age groups (11-15 years). Seroprevalence of HCV was higher in children from urban (7.7%) than rural (1.2%) residents (P=0.02). Overall, 29 (12.1%) of children had elevated ALT. Of these, 31.5% were from HBsAg or anti-HCV antibody positive children whereas 9.8% were from hepatitis B or C virus negative children (P=0.001). Multivariate logistic regression showed that being positive for HBsAg or anti-HCV antibody (AOR: 4.7(95% CI: 1.5-13.5) was significantly associated with elevated ALT. CONCLUSION HBV and HCV co-infections are common in HIV positive children. In HIV positive children, HBV and HCV co-infection were associated with elevate ALT. Routine screening for HBV and HCV in HIV infected children should be implemented.
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Affiliation(s)
- Bayeh Abera
- Department of Medical Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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