Nevirapine
(Viramune) Is Linked with Reduced Liver Fibrosis Progression in HIV-HCV Coinfected
Patients
By
Liz Highleyman
Some
antiretroviral drugs can cause
liver toxicity, and research has consistently shown that the risk of hepatotoxicity
is elevated in HIV positive people with pre-existing
liver disease, including chronic hepatitis B or
C coinfection.
One drug associated with
liver toxicity in several prior studies is nevirapine
(Viramune). Specifically, nevirapine has been linked to liver inflammation
that may be related to a hypersensitivity reaction. This seems to occur more often
in people with relatively high CD4 cell counts (> 250 cells/mm3 for women and
> 400 cells/mm3 for men).
But antiretroviral
therapy that includes nevirapine
may reduce the risk of liver
fibrosis progression in HIV-HCV
coinfected individuals, according to a report in the January 1, 2008 issue
of Clinical Infectious Diseases.
Past
research suggests that HIV-HCV coinfected patients experience more rapid liver
disease progression than people with HCV alone; however, effective HAART and CD4
cell recovery may slow or halt fibrosis progression.
In the present study,
Spanish researchers retrospectively analyzed the effect of exposure to non-nucleoside
reverse transcriptase inhibitors (NNRTIs) and protease
inhibitors (PIs) on the progression of liver fibrosis in 201 HIV-HCV coinfected
patients.
Participants underwent liver biopsies and fibrosis was staged
according to the METAVIR system (F0 or absent fibrosis through F4 or cirrhosis).
The investigators used multinomial logistic regression analysis and the fibrosis
progression rate to assess the association between cumulative exposure to antiretroviral
drugs and fibrosis stage.
Results
•
The
adjusted odds ratio (AOR) of having a fibrosis score of F0 or F1 (absent or minimal),
compared with F3 or F4 (severe), increased with each additional year of exposure
to:
•
HAART
overall: AOR 1.32;
•
NNRTIs as a class: AOR 1.64;
•
efavirenz (Sustiva): AOR 1.54;
•
nevirapine: AOR 1.72.
•
This
effect was not observed with PIs as a class.
•
The
AOR of having a fibrosis score of F2 (significant) versus F3 or F4 increased with
each additional year of exposure to:
•
NNRTIs as a class: AOR 1.51;
•
nevirapine: AOR 1.58.
•
This
effect was not observed with HAART overall, PIs, or efavirenz.
•
The
AOR of having a fibrosis progression rate ? 0.1 versus > 0.1 increased with
each additional year of exposure to:
•
HAART: AOR 1.31;
•
NNRTIs: AOR 1.33;
•
nevirapine: AOR 1.44.
•
This
effect was not seen with PIs or efavirenz.
•
Longer
duration of NNRTI or nevirapine use was associated with reduced fibrosis progression.
Conclusion
"In
contrast with previous studies, we found that exposure to NNRTIs was clearly associated
with a reduction in fibrosis progression, whereas exposure to PIs was not,"
the authors wrote in conclusion.
Of note, they added, "exposure to
nevirapine was more consistently associated with a reduction in fibrosis progression
than was exposure to efavirenz. Prospective work is needed in this area."
HIV
Infectious Diseases Unit, Biomedical Research Foundation, Histopathology Service,
Pharmacy Service, and Molecular Immunobiology Laboratory, Hospital General Universitario
"Gregorio Marañón," Madrid, Spain.
1/15/08
Reference
J
Berenguer, JM Bellon, P Miralles, and others. Association between exposure to
nevirapine and reduced liver fibrosis progression in patients with HIV and hepatitis
C virus coinfection. Clinical Infectious Diseases 46(1): 137-143. January
1, 2008.
