HAART and liver: is it safe?

Abstract

Introduction: Liver disease caused by hepatitis C virus (HCV) is a major cause of morbidity in HIV patients. This study investigates the possibility that chronic HCV increases the risk of hepatotoxicity after highly active antiretroviral therapy (HAART) initiation. Methodology: The data from 30 coinfected HIV/HCV and 35 HIV monoinfected patients between August 2008 and August 2010, since the start of HAART, were analyzed along with data from every three months, with clinical/laboratory evaluation until the end of twelve months. The aim of this study was to assess risk and incidence of hepatotoxicity in both groups. Results: Before the introduction of HAART, coinfected patients had higher average levels of transaminases than did the monoinfected group (p < 0.001). After initiation of HAART, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in coinfected patients, regardless of type of HAART they received. Twenty-two (73%) of the coinfected patients had some degree of hepatotoxicity versus only seven (20%) of the monoinfected patients. No patient had severe hepatotoxicity. Risk of hepatotoxicity after HAART in a coinfected patient was 3.7 times higher than in a monoinfected patient .4], p < 0.001).Conclusions: This study demonstrates that coinfected patients are at an increased risk for developing hepatotoxicity, but the clinical and immunological benefits of HAART are higher than the risk of hepatotoxicity and rarely justify discontinuation of therapy.

Association of serum albumin and aspartate transaminase with 5-year all-cause mortality in HIV/hepatitis C virus coinfection and HIV monoinfection

“…Coinfection with HCV occurs in approximately 25% of HIV-infected persons, but contributes to the majority (50–75%) of liver deaths in the HIV-infected population[2]. Both HIV monoinfection and HIV/HCV coinfection are associated with perturbations in liver injury markers -- aspartate (AST) and alanine (ALT) aminotransferase -- and liver synthetic function, as denoted by serum albumin[3, 4]. …”

Avaliação do dano hepático em pacientes HIV positivo sob terapia antirretroviral no município de Carazinho/RS

“…Segundo Henry, o declínio gradativo das transaminases, nesses casos, ocorre e não causa aumento das mesmas. Além disso, os níveis mais altos de AST e ALT são apresentados naqueles pacientes com coinfecção, o que não é presente no nosso estudo 35 , sendo que os pacientes apresentam uma resposta imunlógica boa em relação a hepatotoxicidade em comparação com pacientes co-infectados.…”

Hiv and Hepatitis C Virus Coinfection. Who Is This Patient Today?

“…Vicente Sperb ANTONELLO 1,2,3 , Ivan Carlos Ferreira ANTONELLO 4 , Rosana Ferrazza ZALTRON 5 and Cristiane Valle TOVO 3,6 illicit drugs and alcohol, previous diagnosis of hypertension, diabetes mellitus, chronic hepatitis B infection, HCV and dyslipidemia, lipid levels, glucose level, urianalysis, measure of arterial hypertension, drugs in use, current CD4 counts (cells/ mm 3 ), current plasma HIV RNA level (viral load), and type of antiretroviral under use. Patients with previous history of HCV treatment, regardless their virological response were excluded from analysis.…”

“…The epidemiologic pattern of the human immunodeficiency virus (HIV) infection and its treatment approaches have changed since this disease, currently considered chronic, was first acknowledged in 1981 (3,24) . Besides HIV, the coinfection HIV/Hepatitis C virus (HCV) has been major prominent in this scenario due to high prevalence and similar transmission routes (3,6,24) .…”

“…The epidemiologic pattern of the human immunodeficiency virus (HIV) infection and its treatment approaches have changed since this disease, currently considered chronic, was first acknowledged in 1981 (3,24) . Besides HIV, the coinfection HIV/Hepatitis C virus (HCV) has been major prominent in this scenario due to high prevalence and similar transmission routes (3,6,24) . The increase in the survival following the introduction of highly active antiretroviral therapy (HAART) has seen the emergence of HCV infection, renal and cardiovascular diseases as important morbidity and mortality causes together with HIV (22,35) .…”