HIV/AIDS Research

Coinfection with hepatitis B or C does not necessarily rule out antiretroviral therapy for HIV patients

Many people who are infected with the human immunodeficiency virus (HIV) that causes AIDS are also infected with hepatitis C virus (HCV) and hepatitis B virus (HBV), which damage the liver. These individuals can develop liver toxicity when they receive antiretroviral therapy for HIV. However, the risk varies substantially, depending on the specific antiretroviral medication, and is not sufficient to withhold antiretroviral therapy from these patients, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07809).

The study found that risk for severe liver toxicity was increased five-fold in patients taking the protease inhibitor (PI) ritonavir, which accounted for half of all toxicity cases. Liver toxicity risk was lower and similar with nelfinavir, indinavir, saquinavir, and nucleoside analog (NA) regimens.

However, more studies are needed in this area, according to the researchers who are from the Johns Hopkins University Schools of Medicine and Public Health. They assessed liver toxicity among 298 HIV-infected patients of a university-based urban HIV clinic who were prescribed new antiretroviral therapies between 1996 and 1998; 71 percent of the patients received PIs as part of combination therapy, and 29 percent received dual NA regimens.

Of these patients, 52 percent had chronic HCV infection and nearly 3 percent had chronic HBV infection. The incidence of toxicity was five-fold higher with use of ritonavir (30 percent) compared with nucleoside analogs (6 percent), nelfinavir (6 percent), saquinavir (6 percent), and indinavir (7 percent). Although chronic viral hepatitis was associated with a nearly four-fold increase in risk of severe liver toxicity among patients prescribed nonritonavir regimens, most patients with chronic hepatitis infection (88 percent) did not experience significant toxic effects. Rate of severe toxicity with use of any PI in patients with HCV infection was 12 percent. However, no irreversible outcomes were seen in patients with severe hepatotoxicity.

Details are in "Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection," by Mark S. Sulkowski, M.D., David L. Thomas, M.D., M.P.H., Richard E. Chaisson, M.D., and Richard D. Moore, M.D., in the January 5, 2000 Journal of the American Medical Association 283(1), pp. 74-80.

Return to Contents
Proceed to Next Article