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Risk Factors for Severe Hepatic Injury After Introduction of Highly Active Antiretroviral Therapy
- Source :
- Scopus-Elsevier
- Publication Year :
- 2001
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2001.
-
Abstract
- Objectives Treatment of HIV infection with highly antiretroviral therapy (HAART) may be limited by liver toxicity. Its incidence and risk factors are not well known. Patients and methods Retrospective chart review. Naive patients beginning HAART between January 1997 and January 2000. Severe transaminase elevation was defined as fivefold or higher rise over upper normal limits, or as > or =3.5-fold rise above abnormal baseline values. Results Of 222 study subjects, 38%, 5%, and 2% were coinfected with hepatitis C virus (HCV), hepatitis B virus, and hepatitis D virus, respectively. Besides two nucleoside reverse transcriptase inhibitors (NRTIs), 96 patients received protease inhibitors (PIs), 90 received nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 35 received a PI + NNRTI combination. Severe hepatic injury developed in 21 (9%): 10% PI, 9%, and 9% PI + NNRTI. Both univariate and multivariate analyses identified alcohol abuse, HCV coinfection, and older age as independent risk factors. Predictor variables in the final multivariate model were: alcohol abuse (risk ratio [RR], 5.87; 95% confidence interval [CI], 1.49-23.15; p =.01], positive HCV serology (RR, 3.99; 95% CI, 1.32-12.10; p =.01], and older age (RR, 1.11; 95% CI, 1.04-1.18; p = 0.001). Conclusions Nearly 10% of study subjects who start HAART experience severe transaminase elevation, irrespective of the treatment. Avoidance of alcohol abuse, especially in study subjects coinfected with HCV, will reduce the risk of hepatic injury after HAART. When possible, prior treatment for chronic HCV infection should be considered.
- Subjects :
- Adult
Male
medicine.medical_specialty
Hepatitis, Viral, Human
Anti-HIV Agents
Hepatitis C virus
HIV Infections
Biology
medicine.disease_cause
Orthohepadnavirus
Risk Factors
Antiretroviral Therapy, Highly Active
Internal medicine
medicine
Humans
Pharmacology (medical)
Aspartate Aminotransferases
Risk factor
Aged
Retrospective Studies
Hepatitis
Hepatitis B virus
Reverse-transcriptase inhibitor
Incidence
Liver Diseases
virus diseases
Alanine Transaminase
Middle Aged
medicine.disease
biology.organism_classification
Treatment Outcome
Infectious Diseases
Liver
Immunology
Coinfection
Reverse Transcriptase Inhibitors
Female
Hepatitis D virus
Chemical and Drug Induced Liver Injury
medicine.drug
Subjects
Details
- ISSN :
- 15254135
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Accession number :
- edsair.doi.dedup.....06ed1056f09fd20ed4eb916e08e7d97e