Abstract
Introduction. Hepatotoxicity is a concern in HIV/hepatitis C virus (HCV) coinfected patients due to their underlying liver disease. This study assessed the incidence of hepatotoxicity in HIV/HCV co-infected patients in two outpatient infectious diseases clinics. Methods. HIV/HCV co-infected adults were included in this retrospective study if they were PI or NNRTI naïve at their first clinic visit and were initiated on an NNRTI- and/or PI-based antiretroviral regimen. Patients were excluded if they had active or chronic hepatitis B virus (HBV). The primary objective was to determine the overall incidence of severe hepatotoxicity. Results. Fifty-six of the 544 patients identified met inclusion criteria. The incidence of severe hepatotoxicity was 10.7% (6/56 patients). Severe hepatotoxicity occurred with efavirenz (N = 2), nevirapine (N = 1), indinavir (N = 1), nelfinavir (N = 1), and saquinavir/ritonavir (N = 1). Conclusion. The incidence of severe hepatotoxicity appears to be low in this retrospective analysis of HIV/HCV co-infected patients receiving a PI-and/or NNRTI-based regimen.
Highlights
Hepatotoxicity is a concern in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients due to their underlying liver disease
This study evaluated the effect of highly active antiretroviral therapy (HAART) and hepatotoxicity in HIV/HCV coinfected patients beginning with their initial visit at the Duke University Medical Center (DUMC) Infectious Diseases Clinic and the Durham Veterans Affairs Medical Center (DVAMC) Infectious Diseases Clinic between August 1, 1994 and December 31, 2006
Questions regarding the safest antiretrovirals to use in this patient population have been investigated in several published clinical trials; many of these studies included patients who were infected with hepatitis B virus (HBV)
Summary
Hepatotoxicity is a concern in HIV/hepatitis C virus (HCV) coinfected patients due to their underlying liver disease. The incidence of severe hepatotoxicity appears to be low in this retrospective analysis of HIV/HCV co-infected patients receiving a PI-and/or NNRTI-based regimen. The advent of highly active antiretroviral therapy (HAART) in the treatment of human immunodeficiency virus (HIV) infection has significantly decreased the incidence of opportunistic infections as well as improved morbidity and mortality among HIV patients. Along with these positive outcomes, HAART is associated with a host of adverse reactions such as hepatotoxicity, hyperlipidemia, hyperglycemia, and lactic acidosis. Often these patients have elevated liver function tests secondary to chronic HCV infection, which can be aggravated with the addition of hepatotoxic antiretrovirals for the treatment of their HIV infection
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