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

IMPACT OF PROGRESSIVE LIVER DAMAGE ON FIRST HAART DISCONTINUATION IN HIV-1 INFECTED PATIENTS: SIX YEAR FOLLOW-UP

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe2.1B04

Uberti-Foppa C., Gallotta G., De Bona A., Galli L., Sagnelli C., Salpietro S., Lazzarin A., Castagna A.
San Raffaele Scientific Institute, Milan, Italy

INTRODUCTION: Little is known about tolerability of HAART in patients with progressive liver damage. Aim of this study was to evaluate the relation between liver damage and discontinuation of the first HAART.

METHODS: In our database we retrospectively reviewed 526 HIV infected subjects initiating their first HAART between January 1997 and April 2003. We stored clinical-immuno-virological and liver related parameters every three months. Liver damage was stratified according to necrosis (high level of ALT), cholestasis (elevated bilirubin, GGT or ALP) and impaired synthesis (low albumin or cholinesterase). Univariate (Chi-square test, Mann-Whitney rank sum test, Kaplan-Meier curves) and multivariate (Cox proportional hazards model) analysis of risk factors associated with modification due to discontinuation or toxicity were performed.

RESULTS: Over a median follow-up of 11 months: 425 (81 %) patients discontinued (modified or stopped) HAART, 280 (53%) stopped all drugs after a median time of 7.5 and 5.4 months respectively. The main types of toxicity associated to discontinuation were gastrointestinal intolerance (18%), allergy (6%) and other toxicity (26%) including severe liver toxicity (7%). At univariate analysis and at Kaplan-Mayer curves, discontinuation occurred in patients with necrosis (elevated ALT: p=0.013 and p=0.05 respectively), impaired cholestasis (elevated ALP: p=0.029; p=0.042), HCV co-infection (p=0.003; p=0.0009) and PI-based therapy (p <0.0001; p=0.004). HAART discontinuing occurred significantly earlier also in patients with low albumin (Chi-square test p=0.042). Factors independently associated to discontinuation of HAART were: albumin (RR= 4.7, 95%IC(RR): 1.5-14.3, p=0.006), CD4 count (RR= 0.4, 95%IC(RR): 0.2-0.9, p=0.03) and PI-based therapy (RR= 2.5, 95%IC(RR): 1.3-4.9, p=0.0081).

CONCLUSIONS: Liver disease (low albumin) and not HCV co-infection could be predictive of a higher discontinuation of HAART, especially in patients who receive PI-based therapy.

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050724
Basic | TuPe2.1B04 | Anna De Bona
Metaanalysis of adverse events in different settings

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