Risk Factors for Severe Hepatic Injury After Introduction of Highly Active Antiretroviral Therapy
- 1 August 2001
- journal article
- Published by Wolters Kluwer Health in JAIDS Journal of Acquired Immune Deficiency Syndromes
- Vol. 27 (5) , 426-431
- https://doi.org/10.1097/00126334-200108150-00002
Abstract
Treatment of HIV infection with highly antiretroviral therapy (HAART) may be limited by liver toxicity. Its incidence and risk factors are not well known. Retrospective chart review. Naive patients beginning HAART between January 1997 and January 2000. Severe transaminase elevation was defined as fivefold or higher rise over upper normal limits, or as > or =3.5-fold rise above abnormal baseline values. Of 222 study subjects, 38%, 5%, and 2% were coinfected with hepatitis C virus (HCV), hepatitis B virus, and hepatitis D virus, respectively. Besides two nucleoside reverse transcriptase inhibitors (NRTIs), 96 patients received protease inhibitors (PIs), 90 received nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 35 received a PI + NNRTI combination. Severe hepatic injury developed in 21 (9%): 10% PI, 9%, and 9% PI + NNRTI. Both univariate and multivariate analyses identified alcohol abuse, HCV coinfection, and older age as independent risk factors. Predictor variables in the final multivariate model were: alcohol abuse (risk ratio [RR], 5.87; 95% confidence interval [CI], 1.49-23.15; p =.01], positive HCV serology (RR, 3.99; 95% CI, 1.32-12.10; p =.01], and older age (RR, 1.11; 95% CI, 1.04-1.18; p = 0.001). Nearly 10% of study subjects who start HAART experience severe transaminase elevation, irrespective of the treatment. Avoidance of alcohol abuse, especially in study subjects coinfected with HCV, will reduce the risk of hepatic injury after HAART. When possible, prior treatment for chronic HCV infection should be considered.Keywords
This publication has 18 references indexed in Scilit:
- Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infectionAIDS, 2000
- Hepatitis B or Hepatitis C Virus Infection Is a Risk Factor for Severe Hepatic Cytolysis after Initiation of a Protease Inhibitor-Containing Antiretroviral Regimen in Human Immunodeficiency Virus-Infected PatientsAntimicrobial Agents and Chemotherapy, 2000
- Risks and benefits of replacing protease inhibitors by nevirapine in HIV-infected subjects under long-term successful triple combination therapyAIDS, 2000
- Recurrent NNRTI-Induced Hepatotoxicity in an HIV-HCV-Coinfected PatientAnnals of Pharmacotherapy, 2000
- Hepatotoxicity Associated With Antiretroviral Therapy in Adults Infected With Human Immunodeficiency Virus and the Role of Hepatitis C or B Virus InfectionJAMA, 2000
- Severe hepatic cytolysis: incidence and risk factors in patients treated by antiretroviral combinations Aquitaine Cohort, France, 1996-1998AIDS, 1999
- Efavirenz: shifting the HAART paradigm in adult HIV-1 infectionExpert Opinion on Investigational Drugs, 1999
- Hepatotoxicity after introduction of highly active antiretroviral therapyAIDS, 1998
- Severe hepatitis in three AIDS patients treated with indinavirThe Lancet, 1997
- Drug Evaluations Anti-infectives: Nevirapine: A review of its development, pharmacological profile and potential for clinical useExpert Opinion on Investigational Drugs, 1996