Journal Article

Association between Exposure to Nevirapine and Reduced Liver Fibrosis Progression in Patients with HIV and Hepatitis C Virus Coinfection

Juan Berenguer, José M. Bellón, Pilar Miralles, Emilio Álvarez, Isabel Castillo, Jaime Cosín, Juan Carlos López, Matilde Sánchez Conde, Belén Padilla and Salvador Resino

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 1, pages 137-143
Published in print January 2008 | ISSN: 1058-4838
Published online January 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/524080
Association between Exposure to Nevirapine and Reduced Liver Fibrosis Progression in Patients with HIV and Hepatitis C Virus Coinfection

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Background. We analyzed the effect of exposure to nonnucleoside reverse‐transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) on the progression of liver fibrosis in patients with human immunodeficiency virus (HIV) and hepatitis C virus coinfection.

Methods. We analyzed data and liver biopsy findings for 201 coinfected patients. Fibrosis was scored following the French METAVIR Cooperative Study Group. We used multinomial logistic regression analysis and the fibrosis progression rate to assess the association between cumulative exposure to antiretroviral drugs and stage of fibrosis.

Results. The adjusted odds ratio (AOR) and 95% confidence interval (CI) of having a fibrosis stage score of 0 or 1, compared with 3 or 4, increased with each additional year of exposure to HAART (AOR, 1.32; 95% CI, 1.04–1,67), to NNRTIs as a class (AOR, 1.64; 95% CI, 1.18–2.27), to efavirenz (AOR, 1.54; 95% CI, 1.03–2.30), and to nevirapine (AOR, 1.72; 95% CI, 1.15–2.78). This effect was not found with PIs as a class. The AOR (95% CI) of having a fibrosis stage score of 2 versus 3 or 4 increased with each additional year of exposure to NNRTIs (AOR, 1.51; 95% CI, 1.08–2.10) and nevirapine (AOR, 1.58; 95% CI, 1.06–2.37). This effect was not found with highly active antiretroviral therapy, PIs, or efavirenz. The AOR (95% CI) of having a fibrosis progression rate ⩽0.1 versus >0.1 increased with each additional year of exposure to highly active antiretroviral therapy (AOR, 1.31; 95% CI, 1.07–1.60), to NNRTIs (AOR, 1.33; 95% CI, 1.03–1.70), and to nevirapine (AOR, 1.44; 95% CI, 1.07–1.95). This effect was not found with PIs or with efavirenz.

Conclusions. 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. Of note, 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.

Journal Article.  3979 words.  Illustrated.

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

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