Journal Article

Influence of Liver Fibrosis on Highly Active Antiretroviral Therapy—Associated Hepatotoxicity in Patients with HIV and Hepatitis C Virus Coinfection

Lidia Aranzabal, José L Casado, Javier Moya, Carmen Quereda, Sergio Diz, Ana Moreno, Leonor Moreno, Antonio Antela, Maria J. Perez-Elías, Fernando Dronda, Ana Marín, Felix Hernandez-Ranz, Alberto Moreno and Santiago Moreno

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 4, pages 588-593
Published in print February 2005 | ISSN: 1058-4838
Published online February 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/427216
Influence of Liver Fibrosis on Highly Active Antiretroviral Therapy—Associated Hepatotoxicity in Patients with HIV and Hepatitis C Virus Coinfection

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Background. Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is a known risk factor for hepatotoxicity in patients receiving highly active antiretroviral therapy (HAART). The aim of this study was to evaluate the role of HCV-related liver fibrosis in HAART-associated hepatotoxicity.

Methods. In a prospective study involving 107 patients who underwent liver biopsy, fibrosis was graded according 5 stages, from F0 (no fibrosis) to F4 (cirrhosis). Hepatotoxicity was defined as an increase in levels of aspartate aminotransferase and alanine aminotransferase to >5 times the upper limit of normal, or a >3.5-fold increase if baseline levels were abnormal. The incidence of hepatotoxicity was compared with liver fibrosis stage and with time and composition of HAART.

Results. Overall, 27 patients (25%) had hepatotoxic events (5.1 events/100 person-years of therapy). The incidence was greater for patients with stage F3 or F4 fibrosis (38%) than for those with stage F1 or F2 fibrosis (15%; 7.6 vs. 3 events/100 person-years; relative risk, 2.75; 95% confidence interval, 1.08–6.97; P = .013). Duration of HCV infection, duration of HAART, diagnosis of acquired immunodeficiency syndrome, HCV load, HCV genotype, and nadir CD4+ cell count did not affect the risk of hepatotoxicity. Of the 86 patients who received nonnucleoside reverse-transcriptase inhibitors (NNRTIs), 11 (13%) developed liver toxicity. In these patients, fibrosis stages F1 and F2 were associated with similar rates of toxicity (3 events/100 person-years for patients who received nevirapine, 3.3 events/100 person-years for those who received efavirenz, and 3.4 events/100 person-years for those who received non-NNRTIs). There was a greater incidence among patients with F3 or F4 fibrosis who received NNRTIs (11.7 events/100 person-years for patients who received nevirapine, and 8.6 events/100 person-years for those who received efavirenz), compared with those who received non-NNRTIs (4 events/100 person-years).

Conclusions. HAART-associated hepatotoxicity correlates with liver histological stage in patients coinfected with HIV and HCV. There was no difference in hepatotoxicity risk for different antiretroviral therapies in patients with mild-to-moderate fibrosis.

Journal Article.  3861 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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