Antiretroviral drugs and liver injury

Soriano, Vincent; Puoti, Massimo; García-Gascó, Pilar; Rockstroh, Juergen; Benhamou, Yves; Barreiro, Pablo; McGovern, Barbara

doi:10.1097/qad.0b013e3282f0e2fd

Cited by 181 publications

(149 citation statements)

References 115 publications

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“…I refer to past reviews for previous information on the subject. [1][2][3][4][5][6][7][8] After those publications, prescription patterns and guideline recommendations have continued to evolve, and physicians treating HIV in 2010 manage new antiretroviral drugs and new aspects of the epidemics. 9 This review focuses on the clinical consequences of liver toxicity associated with HAART, updates information on the subject, and includes liver safety data of most recently approved antiretroviral drugs.…”

mentioning

confidence: 99%

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Núñez

2010

Hepatology

160

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Highly active antiretroviral therapy (HAART)-related hepatotoxicity complicates the management of patients infected with human immunodeficiency virus (HIV), increases medical costs, alters the prescription patterns, and affects the guideline recommendations. Among the clinical consequences derived from HAART-related liver toxicity, hypersensitivity reactions and lactic acidosis are recognized as acute events with potential to evolve into fatal cases, whereas there seems to be other syndromes not as well characterized but of equal concern as possible long-term liver complications. Belonging to the latter category of syndrome, HAART-related nonalcoholic steatohepatitis, liver fibrosis, portal hypertension, and nodular regenerative hyperplasia are discussed in this review. Updated information on liver toxicity of current antiretroviral drugs, including the most recently licensed, is provided. Management and prevention of liver toxicity among HIV-infected patients treated with HAART are reviewed as well.

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mentioning

confidence: 99%

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Núñez

2010

Hepatology

160

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“…In the same year, 25% of all TB deaths (360,000), and 25% of all deaths in HIV positive people (1.5 million) were in co-infected HIV-TB patients. 12 Today we have effective multi drug therapy in form of ART and ATT for HIV and MTb infections respectively. But both ART and ATT are potentially hepatotoxic.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 The other risk factors associated with ART/ATT related DILI are Hepatitis B/C co-infection, poor nutrition status, low albumin levels, low CD4 cell count, pre-existing chronic liver disease, abnormal liver function tests (LFTs) at baseline, age >35 years, female gender and significant alcohol consumption. [8][9][10][11][12] This study was carried out with an aim to study the LFT abnormalities in ATT naive HIV positive patients who were started on ATT and to study the pattern of liver dysfunction in these patients.…”

Section: Introductionmentioning

confidence: 99%

Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

Puri

Kaur

Pathania

et al. 2017

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 1 2 -1Methods: HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapinebased ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks. Results:We studied 100 patients with HIV ([M -67, F -23], mean age: 40.05 AE 10.75 years, mean CD4 cell count: 239.157 AE 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT ( p = 0.044) and with baseline LFT abnormalities ( p = 0.00016). There was no case of acute liver failure or mortality. Conclusion:Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.

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“…In general, most of the drug-induced liver injury is difficult to predict and hence it has been advised that the clinician must be aware of the patient's predisposing risk factors for ARV drugs induced liver injury, which will help them in guiding and monitoring the patient (Soriano et al, 2008). Regularly monitoring the levels of transaminases (AST and ALT) should be made mandatory before commencement and during ARV therapy.…”

Section: Management and Prevention Of Arv-induced Hepatotoxicitymentioning

confidence: 99%

“…Though HAART have its potential to reduce progression of the disease in patients, they still have certain side effects which include liver toxicity, hematuria, decreased bone density, cardiovascular disease, gastrointestinal tract infection, hypersensitivity reaction, lactic acidosis, lipodystrophy, myopathy and Steven-Johns syndrome, etc. (Soriano et al, 2008). One of the major side effects caused by ART is hepatotoxicity (Priyanka and Ezhilarasan, 2014).…”

Section: Introductionmentioning

confidence: 99%

HAART and Hepatotoxicity

2017

J App Pharma Sci

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Antiretroviral (ARV) drugs are given in combination to treat the human immunodeficiency virus (HIV)infection and to prolong the life expectancy of the patient. The increase in the levels of hepatotoxicity due to the use of above drugs has been the concern till date. Lactic acidosis, hepatocytes fatty infiltration and oxidative stress are the commonly associated hepatotoxic effects with the administration of nucleoside reverse transcriptase inhibitors. Non-nucleooside reverse transcriptase inhibitors such as nevirapine and efavirenz inhibit bile acid transport causing cholestasis which in turn causes apoptosis to the hepatocytes. Furthermore, hepatitis C and B virus co-infection and Tuberculus bacilli in HIV infected patients remains a vital risk factor for the development of hepatotoxicity associated with highly active antiretroviral therapy (HAART). Overwhelming evidences clearly shows that the ARV drugs mediated hepatotoxicity has been attributed due to their mitochondrial interference. Although a low grade of hepatotoxicity resolves, high levels of toxicity leads to discontinuation of the therapy. Hence, careful observation is necessary especially during and after HAART to study the drug-induced liver diseases.

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Antiretroviral drugs and liver injury

Cited by 181 publications

References 115 publications

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

HAART and Hepatotoxicity

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