HAART and liver: is it safe?

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. The data from 30 coinfected HIV/HCV and 35 HIV m...

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Bibliographic Details
Published in:	Journal of infection in developing countries Vol. 8; no. 11; pp. 1444 - 1450
Main Authors:	Antonello, Vicente Sperb, Kliemann, Dimas Alexandre, Rigel Santos, Breno, Tovo, Cristiane Valle
Format:	Journal Article
Language:	English
Published:	Italy Journal of Infection in Developing Countries 13-11-2014
Subjects:	Adult Anti-Retroviral Agents - adverse effects Anti-Retroviral Agents - therapeutic use Antiretroviral Therapy, Highly Active - adverse effects Chemical and Drug Induced Liver Injury - epidemiology Female Hepatitis C Hepatitis C, Chronic - complications HIV Infections - complications HIV Infections - drug therapy Humans Male Middle Aged Patients Prospective Studies Risk Assessment
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Summary:	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. 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. 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 (RR 3.7 [1.8-7.4], p < 0.001). 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.
ISSN:	1972-2680 2036-6590 1972-2680
DOI:	10.3855/jidc.5012