Objective: To determine the distribution of markers of liver function disorders and
their association with co-existing fluids and electrolytes states in ambulatory HIV
infected individuals.
Design: A case-control study.
Setting: Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient Support
Centre.
Intervention: Biochemical analysis were performed for serum alanine-aminotranferase
(ALT), aspartate-amino transferase (AST), total protein, albumin, glucose, urea,
potassium, sodium, chloride, creatinine phosphate, total and direct bilirubin levels
as well as CD4 lymphocyte levels.
Results: Serum liver function markers were significantly altered in HIV infected
individuals compared to uninfected individuals (mean serum aspartate-amino
transferase (AST); 45.1U/l v/s 36.9U/l; alanine-aminotransferase (ALT), 36.5U/l v/s
30.7U/l; direct bilirubin, 4.9µmol/l v/s 4.2µmol/l; total bilirubin, 6.2µmol/l v/s 5µmol/l;
albumin32.8g/l v/s 34.5g/l and protein 64g/l v/s 67.1g/l; p <0.0001). The prevalence of
pathological levels of serum liver function markers was also higher in HIV-infected
patients than HIV-negative participants (ALT, 4.4% v/s 0.7%, p=0.001; AST, 24.5% v/s
6.7%, p<0.0001; direct bilirubin, 43.1% v/s 36.5%, p=0.026; total bilirubin, 2.3% v/s 0%,
p=0.002; serum albumin, 60.1% v/s 52.2%, p= 0.009 and serum total protein levels, 52.8%
v/s 36%, p<0.0001). Gender, age and anti-retroviral treatment were not predictors of
aberrations in levels of liver function markers in HIV infected patients. Marked CD4
depletion was associated with enhanced deterioration of liver function markers. Liver
function anomalies did not conduce co-existing electrolyte anomalies as clinically
altered ALT states only correlated and co-varied with AST states (r = 0.917) ; direct
biliribun states co-varied with total bilirubin levels (r = 0.958) and serum album states
correlated with protein levels (r = 0.917) and vice versa.
Conclusion: Liver function disorders are not infrequent in HIV infected individuals and
routine review of liver health status is essential in comprehensive care of HIV patients.