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Journal of Tropical Pediatrics Advance Access published online on August 26, 2009
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmp079
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© The Author [2009]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Low Rates of Hepatotoxicity in HIV-infected Children on Anti-retroviral Therapy with and Without Isoniazid Prophylaxis

Diane Graya,b, James Nuttallb, Carl Lombardc, Mary-ann Daviesd, Lesley Workmanb, Patti Apollesb, Brian Eleyb, Mark Cottone and Heather Zarb

aPaediatric HIV Service, Groote Schuur Hospital, Cape Town, South Africa
bSchool of Child and Adolescent Health, Red Cross Children's Hospital, Univeristy of Cape Town, Cape Town, South Africa
cBiostatistics Unit, Medical Research Council, Cape Town, South Africa
dSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
eKIDCRU, Tygerberg Children's Hospital, Cape Town, South Africa

Correspondence: Diane Gray, Paediatric HIV Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa. Tel: +27 21 4044468; Fax: +27 21 4066169; E-mail: <diane{at}kidzpositive.org>.


  Abstract

This study investigates the incidence of hepatotoxicity in HIV-infected children during anti-retroviral therapy (ART) and the impact of concomitant use of isoniazid preventive therapy. It is a retrospective cohort analysis of HIV-infected children who commenced ART or were followed up between September 1998 and November 2005. Alanine transferase levels were measured at baseline, at 1, 3 and 6 months and then 6 monthly thereafter. Of the 598 children included in the study, 425 were taking ART alone, 73 ART and isoniazid, 39 isoniazid alone and 61 neither isoniazid nor ART. There was no increased risk of hepatotoxicity with ART with or without isoniazid compared to the control group over a 2-year period. Grade 3 or 4 ALT elevations occurred in 19 (3.4%) children, with no cases of fulminant hepatic failure. Severe hepatic events are uncommon in children on ART or isoniazid. There is no increased risk of hepatotoxicity with ART and concurrent isoniazid preventive therapy.

Key Words: hepatic toxicity • human immunodeficiency virus • anti-retroviral therapy • isoniazid preventive therapy • children


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