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

PATTERN OF HEPATOTOXICITY ON DIFFERENT ANTIRETROVIRAL REGIMENS IN HIV-PATIENTS WITH OR WITHOUT CHRONIC HEPATITIS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe2.1B03

Konopnicki D., De Wit S., Poll B., Clumeck N.
Saint-Pierre University Hospital, Brussels, Belgium

INTRODUCTION: To determine the incidence of liver enzymes increase (LEI) after initiation of antiretroviral therapy and to correlate it with sex, ethnicity, CD4 level and chronic hepatitis.

METHODS: Cohort of patients naïve for PI and NNRTI starting between 1996 and 2004 a NNRTI- (n=488), a PI- (n=770) or a triple NRTI- (n=293) based-regimen. Alanine-(ALT) and aspartate-(AST) aminotransferase, alkalin phosphatase (AP) and gamma-glutamyl transpeptidase (GGT) were collected at baseline and during the first year. Patients were classified as hepatitis B (5%) or C (13%) co-infected (H) or not (NH).

RESULTS: The NNRTI, PI and NRTI groups were characterised by a high proportion of female (51-46-46%), Africans (61-51-44%) and chronic hepatitis (15-18-18%). Table 1 shows the proportion of patients with >2 grades LEI. An increase of >2 grades of at least 1 enzyme was more frequent in H vs. NH patients with PI (24% vs. 12%, p=0.0004) or NRTI (14% vs. 4%, p=0.02). For the PI group, the multivariate analysis (including sex, ethnicity, hepatitis status, baseline CD4 >250 cells/µL) showed that chronic hepatitis increased the risk of >2 grades LEI (OR 1.87, 1.12-3.13, p=0.02) while female sex (OR 0.42, 0.24-0.73 , p=0.002) or CD4 >250/µL (OR 0.47, 0.28-0.78, p=0.004) decreased that risk.

CONCLUSIONS: Serious hepatotoxicity occurred in 20% of NNRTI-, 14% of PI- and 6% of NRTI-based therapies. GGT was more frequently increased that ALT/AST whereas increased AP was a rare event. PI and NRTI but not NNRTI increased hepatic abnormalities in chronic hepatitis patients. Female were less at risk for hepatotoxicity on PI and in contrast with previous studies, had no increased risk with NNRTI.

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050724
Basic | TuPe2.1B03 | Deborah Konopnicki
Metaanalysis of adverse events in different settings

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