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

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. © 2017 marti et al.