Biochemical profiles in children with HIV at Gertrudes's children's hospital comprehensive care centre, Nairobi, Kenya
Gatuthu, Peninah N.
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Human Immunodeficiency Virus infection and antiretroviral therapy are associated with complex metabolic alterations. In patients on highly active antiretroviral therapy (HAART), the risk of significant metabolic derangements increases with duration of treatment. Individual drugs or classes of antiretroviral drugs are associated with specific toxicities. Because suppression of viral replication requires long term or even lifelong use of HAAR T, HIV infected children will have the longest exposure with the attendant risk of experiencing adverse side effects. Nucleoside Reverse Transcriptase Inhibitors including didanosine and lamivudine are implicated in mitochondrial toxicity, leading to lactic acidosis. They may also cause elevation of liver enzymes, hyperglycemia and lipodystrophy. Non- Nucleoside Reverse Transcriptase Inhibitors including nevirapine and efavirenz have also been found to cause acute hepatitis. Protease Inhibitors may cause elevation of the liver function tests, abnormal lipids and hyperglycemia. There is very little local data on metabolic derangements in treated Human Immunodeficiency Virus infected children. This study has described some biochemical profiles in Human Immunodeficiency Virus infected children who are either treatment naive or on Highly Active Antiretroviral Therapy (HAART). Non fasting plasma specimens were taken. Biochemical markers of bone metabolism (alkaline phosphates, calcium, phosphorous); hepatocyte damage (Aspartate aminotransaminases, Alanine aminotransaminases); mitochondrial toxicity (lactic acid) and carbohydrate intolerance (glucose) were measured. Approval for the study was obtained from Gertrude Children's Hospital Ethics and Research Committee. An auto analyzer using commercial reagents was used. Of the 133 children studied 81 (60.9%) were on HAART while 52 (39.1 %) were not on treatment. Age ranged from 2 months to l Syears (median 6years). The male to female ratio was 1.5:1. Their CD4 counts ranged from 3 to 2070 cells/mm3 while the viral load ranged from <40 to 4,194,860 copies/ml (median 1,231,772). ARV treatment duration ranged from 0 to 121months (median I 2). Most children had biochemical parameters within the reference ranges. Transaminases elevation was the most common biochemical derangement being found in 15% and 7.4% of treatment naive and HAART patients respectively. All patients had normocalcaemia, mean values 2. 17mmol/l and 2.22mmol/1 in HAART treatment and naive patient's respectively. Mild lactic elevation was found in treatment narve (n=5) and patients on treatment (n=5). All the affected children were between the ages of 1-5years. No correlation was found between the biochemical profiles and the CD4 counts or viral load. Guidelines for initiating ARV therapy recommend estimation of transaminases. This study has found that plasma glucose, lactate, calcium, phosphorous, ALP, ALT and AST in young children with HIV were not elevated due to treatment with HAART. The initiation of HAART in the children was associated with increased T- cell count. There was a reduction in viral load and increased CD4+ cell count in patients on HAAR T treatment. HIV and HAART are not associated with changes in serum biochemical parameters in children. A longitudinal study may unmask such derangements and is recommended with increased use of ART.
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