The prevalence and risk of hepatitis flares in a Serbian cohort of HIV and HCV co-infected patients treated with HAART.

Abstract

Despite substantial benefits of HAART treatment of HIV-infected patients, cumulative long-term toxicity, including drug-induced hepatotoxicity, has emerged as an important complication. Thus, to examine the prevalence and risk of developing severe hepatic injury during HAART, we conducted a retrospective study in a cohort of 364 HIV-infected patients treated with HAART between January 1998 and May 2006, for whom data on alanine aminotransferase activity were available both before and during HAART. HCV co-infection was recorded in 35.4% of the series, but was found not to influence either the efficacy of HAART or survival (P>0.05). Severe hepatotoxicity occurred in a total of 24 patients (6.6%). Multivariate logistic regression defined HCV co-infection (OR 16.6, 95% CI 3.8-46.0, P<0.0001), and the use of SQV/RTV and d4T (OR 3.1, 95% CI 1.2-8.16, P=0.02, and OR 7.1, 95% CI 1.0-54.5, P=0.05, respectively) as independent risk factors for aggravation of hepatitis. In addition, there was a significant increase in the probability of developing liver damage over years of treatment (Log rank, P<0.01). Conversely, the probability of developing hepatotoxicity was not associated with an increase in the CD4 cell count to values greater than 350/microL (Log rank, P=0.59). In conclusion, in the setting of chronic viral hepatitis, hepatotoxicity during HAART may be attributed to the cumulative toxicity of drugs that induce mitochondrial toxicity, along with particular PIs and/or NNRTIs. Furthermore, our data suggest prudent use of D-drugs, still common in resource-limited countries, in HCV co-infected patients.

• Authors: Dj Jevtović, J Ranin, D Salemović, I Pesić, G Dragović, S Zerjav, O Djurković-Djaković
• Journal: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie (Biomed Pharmacother) Vol. 62 Issue 1 Pg. 21-5 (Jan 2008) ISSN: 0753-3322 [Print] France
• PMID: 17223307 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Stavudine
• Saquinavir
• Ritonavir

Topics

• Adolescent
• Adult
• Aged
• Antiretroviral Therapy, Highly Active (adverse effects)
• CD4 Lymphocyte Count
• Female
• Follow-Up Studies
• HIV Infections (complications, drug therapy)
• Hepatitis C, Chronic (complications, pathology)
• Humans
• Liver (drug effects, pathology)
• Liver Function Tests
• Logistic Models
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Risk Factors
• Ritonavir (adverse effects)
• Saquinavir (adverse effects)
• Stavudine (adverse effects)
• Survival Rate
• Time Factors
• Yugoslavia