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All Journal Indonesian Journal of Tropical and Infectious Disease
Tutik Kusmiati
Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Academic Hospital, Surabaya
Earth & Planetary Sciences Health Professions Medicine & Pharmacology Public Health

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Risk Factors for Elevated Transaminases in People Living with Human Immunodeficiency Virus Receiving Antiretroviral Therapy in a Tertiary Hospital Edrick Sugianto; Brian Eka Rachman; Tutik Kusmiati; Muhammad Miftahussurur
Indonesian Journal of Tropical and Infectious Disease Vol. 14 No. 2 (2026): Vol. 14 No. 2 (2026)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v14i2.79848

Abstract

People living with HIV (PLHIV) who receive antiretroviral therapy (ART) are at risk of developing liver enzyme abnormalities, particularly transaminase elevation (aspartate aminotransferase and/or alanine aminotransferase above the upper limit of normal), due to multiple factors, including immune status, coinfections, and concomitant hepatotoxic drugs. This study aimed to evaluate risk factors associated with transaminase elevation among PLHIV receiving ART at a tertiary hospital in Surabaya, Indonesia. A retrospective age-matched case-control design was conducted using medical records from 2020 to 2022, involving 35 cases with elevated transaminases and 35 matched controls. Data on gender, nutritional status, nadir CD4 counts, hepatitis B and C coinfection, and use of hepatotoxic drugs were analyzed. Bivariate analysis showed that underweight status (OR 3.37; 95% CI 1.11–10.27; p=0.029), nadir CD4 count <200 cells/µL (OR 12.50; 95% CI 2.44–63.96; p=0.001), first-line antituberculosis drug use (OR 11.50; 95% CI 3.55–37.28; p<0.001), fluconazole use (OR 6.00; 95% CI 1.50–23.99; p=0.007), and cotrimoxazole use (OR 9.43; 95% CI 1.92–46.41; p=0.002) were significantly associated with transaminase elevation. In multivariate analysis, nadir CD4 count <200 cells/µL (AOR 8.67; 95% CI 1.49–50.34; p=0.016) and first-line antituberculosis drug use (AOR 6.67; 95% CI 1.40–31.92; p=0.017) remained independent risk factors. These findings suggest that advanced immunosuppression and concomitant antituberculosis therapy are major contributors to liver injury in this population. Routine monitoring of liver function and careful management of co-administered hepatotoxic drugs are recommended to ensure the safety of ART in PLHIV.
Co-Authors Brian Eka Rachman Edrick Sugianto Muhammad Miftahussurur