<![CDATA[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.]]>
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