Liver Toxicity of Initial Antiretroviral Drug Regimens Including Two Nucleoside Analogs Plus One Non-Nucleoside Analog or One Ritonavir-Boosted Protease Inhibitor in HIV/HCV-Coinfected Patients
Por:
Macias, J, Neukam, K, Mellolas, J, Lopez-Cortes, LF, Carton, JA, Domingo, P, Moreno, S, Iribarren, JA, Clotet, B, Crespo, M, de Los Santos, I, Ortega, E, Knobel, H, Jimenez-Exposito, MJ, Pineda, JA
Publicada:
1 mar 2012
Resumen:
Objective: To evaluate the incidence and risk factors for grade 3 or 4 ALT or AST elevations (TE) and grade 4 total bilirubin elevations (TBE) among HIV/HCV-coinfected treatment-naive patients with an initial regimen including 2 nucleoside analogs plus efavirenz (EFV), nevirapine (NVP), or a ritonavir-boosted protease inhibitor (PI/r). Patients and Methods: This was a retrospective multicenter observational cohort study that recruited 745 HIV-infected drug-naive patients with detectable plasma HCV RNA who started a regimen including EFV, NVP, or PI/r. Results: EFV was prescribed in 323 (43%), NVP in 126 (17%), and a PI/r in 296 (40%) patients. Grade 3 or 4 TE were observed in 19 (5.9%) individuals receiving EFV compared with 14 (11%) on NVP (P = .056) and 31(10.5%) on PI/r (P = .036). Grade 4 TBE were identified in 7(2.2%) patients on EFV, 1(0.8%) on NVP, and 11(3.7%) on PI/r (P = .19). Therapy was discontinued due to liver toxicity in 13 (4%) patients on EFV, 16 (13%) on NVP, and 17 (6%) on PI/r (P = .003). Conclusions: Regimens including EFV, NVP, or PI/r are generally safe in treatment-na ve HIV/HCV-coinfected patients. Grade 3-4 TE are less commonly seen with EFV than with PI/r. Discontinuations due to hepatotoxicity were less frequent for patients receiving EFV than for those treated with NVP.
Filiaciones:
Macias, J:
Hosp Univ Valme, Unidad Enfermedades Infecciosas & Microbiol, Seville 41014, Spain
Neukam, K:
Hosp Univ Valme, Unidad Enfermedades Infecciosas & Microbiol, Seville 41014, Spain
Hosp Clin Barcelona, Infect Dis Unit, Barcelona, Spain
Lopez-Cortes, LF:
Hosp Univ Virgen Rocio, Infect Dis Unit, Seville, Spain
Carton, JA:
Univ Oviedo, Hosp Cent Asturias, Infect Dis Unit, E-33080 Oviedo, Spain
Hosp Donostia, Infect Dis Unit, San Sebastian, Spain
Domingo, P:
Hosp Univ Santa Creu & St Pau, Dept Internal Med, Barcelona, Spain
Moreno, S:
Hosp Univ Ramon y Cajal, Dept Infect Dis, Madrid, Spain
Clotet, B:
Hosp Badalona Germans Trias & Pujol, Unit HIV, Badalona, Spain
Crespo, M:
Hosp Valle De Hebron, Infect Dis Unit, Barcelona, Spain
de Los Santos, I:
Hosp Univ La Princesa, Infect Dis Unit, Madrid, Spain
Ortega, E:
Hosp Gen Univ Valencia, Infect Dis Unit, Valencia, Spain
Knobel, H:
Hosp Mar, Dept Infect Dis, Barcelona, Spain
Jimenez-Exposito, MJ:
Bristol Myers Squibb Co, Madrid, Spain
Pineda, JA:
Hosp Univ Valme, Unidad Enfermedades Infecciosas & Microbiol, Seville 41014, Spain
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