Hepatotoxicity Associated with Antiretroviral Therapy Containing Dual versus Single Protease Inhibitors in Individuals Coinfected with Hepatitis C Virus and Human Immunodeficiency Virus

Cooper, Curtis; Parbhakar, M. A.; Angel, Jonathan B.

doi:10.1086/339867

Cited by 63 publications

(40 citation statements)

References 19 publications

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“…Some authors have postulated that hepatitis C is linked to an increased risk of hepatotoxicity for all antiretroviral regimens [23,24], while others have found an increased risk related to only a few antiretroviral agents, such as ritonavir or nevirapine [21,25]. In the present study, grade 1 and 2 hepatotoxicity was found in 22 patients (73%) in the coinfected group; however, the type of HAART was not associated with hepatotoxicity risk.…”

Section: Discussioncontrasting

confidence: 53%

HAART and liver: is it safe?

Antonello¹,

Kliemann

Santos

et al. 2014

J Infect Dev Ctries

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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.

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Section: Discussioncontrasting

confidence: 53%

HAART and liver: is it safe?

Antonello¹,

Kliemann

Santos

et al. 2014

J Infect Dev Ctries

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“…Toxicity associated with the long-term use of antiretrovirals has to be considered when be- 0 12 24 36 48 60 72 84 96 108 120 132 144 156 before 1988 ginning treatment, sometimes precociously, in clinically stable children with a relatively preserved immune system 30 . Aside from this, the appearance of antiretroviral-resistant HIV strains and problems of adherence to therapy represent two of the major causes for treatment failure 31 .…”

Section: Discussionmentioning

confidence: 99%

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Matida

Ramos

Moncau³

et al. 2007

Cad. Saúde Pública

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Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.

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“…These patients usually respond poorly to treatment with alpha interferon, with or without ribavirin, which may also occasionally cause severe hepatotoxicity (5,23). Moreover, there is evidence indicating that coinfection may accelerate the progression to severe forms of liver disease, such as fibrosing cholestatic hepatitis (29) and cirrhosis (12,27).…”

mentioning

confidence: 99%

Dissociation of Serum and Liver Hepatitis C Virus RNA Levels in Patients Coinfected with Human Immunodeficiency Virus and Treated with Antiretroviral Drugs

Furione

Maserati²,

Gatti

et al. 2004

J Clin Microbiol

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We examined hepatitis C virus (HCV) RNA levels in serum, peripheral blood mononuclear cells (PBMC), and the liver for 135 patients with chronic HCV infections, 44 of whom were human immunodeficiency virus (HIV) positive and treated with highly active antiretroviral therapy (group A), 66 of whom were HIV negative (group B), with abnormal serum alanine aminotransferase (ALT) values, and 25 of whom were HIV negative, with ALT values of <1.5 times the normal value (group C). Patients had not been treated with interferon, with or without ribavirin, at the time of the study. A statistically significant correlation between HCV RNA levels in the liver and serum was reproducibly documented, whereas this was inconsistent for serum and PBMC. A comparative evaluation of HCV RNA levels in the liver and PBMC showed significantly lower values for group A than for groups B and C (P < 0.01 and P < 0.0001, respectively). In contrast, HCV RNA levels in serum were significantly higher for group A than for group B (P < 0.001). A dissociation between HCV RNA levels in serum and the liver was found for patients with HIV-HCV coinfections. Although the relative contribution of extrahepatic reservoirs, including lymphoid cells, to HCV RNA levels in serum is unclear, it may be speculated that a low intrahepatic HCV burden is caused by restored immunocompetence after successful antiretroviral therapy in coinfected patients.

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Hepatotoxicity Associated with Antiretroviral Therapy Containing Dual versus Single Protease Inhibitors in Individuals Coinfected with Hepatitis C Virus and Human Immunodeficiency Virus

Cited by 63 publications

References 19 publications

HAART and liver: is it safe?

HAART and liver: is it safe?

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Dissociation of Serum and Liver Hepatitis C Virus RNA Levels in Patients Coinfected with Human Immunodeficiency Virus and Treated with Antiretroviral Drugs

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