Previous cross-sectional studies suggest that highly active antiretroviral therapy (HAART)
may be associated with mild hepatotoxicity. However, temporal patterns and incidence
of liver enzyme alterations following HAART initiation remain unclear. To prospectively
evaluate CD4+ T-cell recovery and liver enzyme changes before and after HAART initiation
in adult HIV-infected patients. A 12-month prospective cohort study was conducted among
180 HAART-naïve HIV-positive adults. CD4+ count, ALT, AST, ALP, total bilirubin, and
albumin were measured at baseline, 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months
after HAART initiation. Hepatotoxicity was graded using standard toxicity criteria. CD4+
counts significantly increased from baseline \((mean 248 ± 96 cells/ μL)\) to 12 months \((489± 155 cells/ μL, p<0.001)\). Transient elevations of ALT and AST were observed at 6–12 weeks, with \(14.4%\) developing Grade 1–2 hepatotoxicity. Persistent hepatotoxicity beyond 6 months occurred in 3.3% of participants. Regimen switching was associated with increased risk. HAART initiation is associated with early transient hepatocellular enzyme elevations, while long-term severe hepatotoxicity is uncommon. Structured baseline and early follow-up monitoring is essential, particularly within the first 12 weeks of therapy.
