3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

HAART-ASSOCIATED HEPATOTOXICITY IN HIV/HCV CO-INFECTED PATIENTS WITH ADVANCED CHRONIC LIVER DISEASE OR CIRRHOSIS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe1.1C38

Aranzabal L., Casado J., Quereda C., Moya J., Moreno A., Antela A., Marín A., Perez-Elías M.J., Moreno S.
Ramon y Cajal Hospital, Madrid, Spain

INTRODUCTION: HCV co-infection is a known risk factor for hepatotoxicity in HIV-infected patients receiving HAART. However, few data exist about the risk of liver toxicity in patients with advanced chronic liver disease (CLD) or cirrhosis

METHODS: Prospective cohort study of 195 HIV/HCV co-infected patients who underwent liver biopsy between October '00 and September '04. Liver fibrosis was staged using a scoring system of 0 (no fibrosis) to 4 (cirrhosis). Hepatotoxicity was defined as an increase in AST/ALT levels over five times the upper limit of normal, or 3-5 fold increase if baseline levels were abnormal.

RESULTS: Mean age was 40 yrs, 81% were male, and 88% were former IDUs. A more advanced fibrosis degree (3-4) was observed in patients with hepatitis B surface antigen (10 vs 0.5; p=0.01), a longer HCV infection time (21 vs 17 yrs; p<0.01), and increased baseline AST levels (95 vs 69 IU/mL; p=0.04), without relation with RNA HCV, genotype, or other demographic, clinical, or HIV-related variables. Hepatotoxicity was observed in 47 cases (25%, 4.1 cases/100 person-years on therapy). Overall, a greater rate of toxicity was observed in patients with fibrosis 3-4 than with fibrosis 1-2 (5.3 vs. 3.6 cases/100 person-years; 31 vs 21%, p=0.2). After adjusting by alcohol abuse, the risk was significantly higher for fibrosis 3-4 (30% vs 15%; 5 vs 2.3 cases/100 person-years; relative risk 2.5, 95%CI 1.1-5.6; p=0.02). If excluding fibrosis degree, AST/ALT values at baseline (p=0.01), and alcohol abuse (rr 3.3; 95% CI 1.5-7.1, p=0.01) were related to liver toxicity. There was no association between the rate of liver toxicity and demographic data, HIV RNA level, AIDS diagnosis, CD4+ count, or HCV data (genotype, RNA HCV, HAI).

CONCLUSIONS: HAART-associated hepatotoxicity is closely correlated with HCV-related liver histological damage. In patients with advanced CLD, nearly one third could develop toxicity.

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050724
Clinical | TuPe1.1C38 | Lidia Aranzabal
Hepatitis viruses

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