3rd IAS Conference on HIV Pathogenesis and Treatment
July 24 - 27, 2005, Rio de Janerio, Brazil
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Pattern of Hepatotoxicity on Different Antiretroviral Regimens in HIV Patients with or without Chronic Hepatitis B or Hepatitis C The objective of the current study was to determine the incidence of liver enzymes increase (LEI) after initiation of antiretroviral therapy and to correlate it with sex, ethnicity, CD4 level and chronic hepatitis. Study participants were from a cohort of patients naïve for PI and NNRTI starting between 1996 and 2004 a NNRTI- (n=488), a PI- (n=770) or a triple NRTI- (n=293) based-regimen. Alanine-(ALT) and aspartate-(AST) aminotransferase, alkaline phosphatase (AP) and gamma-glutamyl transpeptidase (GGT) were collected at baseline and during the first year. Patients were classified as hepatitis B (5%) or C (13%) co-infected (H) or not (NH). Results · The NNRTI, PI and NRTI groups were characterized by a high proportion of females (51-46-46%), Africans (61-51-44%) and chronic hepatitis B or C (15-18-18%). · An increase of >2 grades of at least 1 enzyme was more frequent in H vs. NH patients with PI (24% vs. 12%, p=0.0004) or NRTI (14% vs. 4%, p=0.02). ·
For
the PI group, the multivariate analysis (including sex, ethnicity,
hepatitis status, baseline CD4 >250 cells/µL) showed that chronic
hepatitis increased the risk of >2 grades LEI, p=0.02) while
female sex, p=0.002) or CD4 >250/µL, p=0.004) decreased that
risk. The authors found that · Serious hepatotoxicity occurred in 20% of NNRTI-, 14% of PI- and 6% of NRTI-based therapies [emphasis added-Ed] · GGT was more frequently increased that ALT/AST whereas increased AP was a rare event. · PI and NRTI but not NNRTI increased hepatic abnormalities in chronic hepatitis patients. · Females were less at risk for hepatotoxicity on PI and in contrast with previous studies, had no increased risk with NNRTI. Saint-Pierre University Hospital, Brussels, Belgium. 08/01/05 Reference
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