Evaluation of Risk Factors for Liver Enzyme Elevation Among Treatment-experienced Patients Using Lopinavir/Ritonavir

The aim of the present study was to evaluate the risk factors for lopinavir/ritonavir/ LPV/r (Kaletra)-related liver enzyme elevation (LEE) in HIV antiretroviral-experienced patients.

An open prospective observational study was carried out to analyze the incidence and time of LEE development during LPV/r treatment, and to determine whether LEE development was correlated with epidemiological, clinical and biochemical data, immune and virological profiles, concomitant hepatic diseases, antiretroviral therapy, or histological and ultrasonography liver examination results.

A diagnosis of LEE was considered when LEE symptoms occurred after LPV/r introduction and was confirmed by a second control within 2 weeks.

Results

A total of 782 HIV-positive outpatients have been enrolled in six different Infectious Diseases Departments in Northern Italy since August 2000. Of these patients, 71 (9.1%) developed LEE within 115+/-85 days (mean+/-standard deviation); 13 of these subjects discontinued LPV/r and four were hospitalized.

Of the patients with LEE, 74.6% and 25.4% had grade 2 and >/=3 toxicity, respectively.

No correlation between LEE and sex, baseline CD4 cell count, viral load, HIV stage, triglyceride values, histological and ultrasonography liver examination results, nevirapine (Viramune) use, or increase in CD4 cell count was observed.

Higher baseline alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) values (P < 0.0001 and P=0.004, respectively), younger age (P=0.008), previous hepatitis B virus (HBV) infection (P=0.012), efavirenz (Sustiva) use (P=0.04), and hepatitis C virus (HCV) and/or HBV coinfection (P < 0.0001, relative risk 4.78) were significantly related to LEE.

No correlations between LEE and the same risk factors as investigated in the whole study population were found in subgroups of patients with HCV and/or HBV infection.

Conclusions

The authors conclude, “HCV and HBV testing and measurement of baseline ALT values are essential for screening subjects at risk of LEE before starting LPV/r. Strict monitoring of clinical and biochemical parameters should be performed in these patients.”

2nd Department of Infectious Diseases, Sacco Hospital, Milan, Italy.

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ALT/AST (liver enzymes)

09/20/04