TITLE

Hepatotoxicity and effectiveness of a Nevirapinebased antiretroviral therapy in HIV-infectedp atients with or without viral hepatitis B or C infection in Cameroon

AUTHOR(S)
Mbougua, Jules B. Tchatchueng; Laurent, Christian; Kouanfack, Charles; Bourgeois, Anke; Ciaffi, Laura; Calmy, Alexandra; Gwet, Henri; Koulla-Shiro, Sinata; Ducos, Jacques; Mpoudi-Ngolé, Eitel; Molinari, Nicolas; Delaporte, Eric
PUB. DATE
January 2010
SOURCE
BMC Public Health;2010, Vol. 10 Issue 1, p105
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-HIV treatment. We compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with HIV only and patients coinfected with hepatitis B or C virus in Cameroon. Methods: A retrospective cohort study was conducted among HIV-1-infected patients. Plasma HBV DNA and HCV RNA were tested in positive or indeterminate samples for HBsAg or HCV antibodies, respectively. All patients received nevirapine and lamivudine plus stavudine or zidovudine. Results: Of 169 HIV-1-infected patients with a median baseline CD4 count of 135 cells/mm3 (interquartile range [IQR] 67-218), 21% were coinfected with HBV or HCV. In coinfected patients, the median viral load was 2.47 × 107 IU/mL for HBV (IQR 3680-1.59 × 108) and 928 000 IU/mL for HCV (IQR 178 400-2.06 × 106). Multivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). The response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of CD4 cell count increase (p = 0.8), HIV-1 viral load below 400 copies/mL (p = 0.9), death (p = 0.3) and death or new AIDS-defining event (p = 0.1). Nevirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. Conclusion: This study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low CD4 cell count in Africa despite frequent coinfections with HBV or HCV and infrequent testing of these infections. Although testing for HBV and HCV should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown.
ACCESSION #
49160889

 

Related Articles

  • Risk Factors for Grade 3—4 Liver Enzyme Elevation in HIV and Hepatitis C Coinfected Patients on Combination Antiretroviral Therapy. Chihrin, S.; Antoniou, T.; Raboud, J.; Shen, S.; Govan, V.; Fletcher, D.; Rachlis, A.; Kovacs, C.; Crouzat, F.; Tilley, D.; Chang, B.; Saskin, R.; Loutfy, Mona R. // AIDS Patient Care & STDs;Jul2007, Vol. 21 Issue 7, p469 

    Although coinfection with hepatitis C (HCV) is an established risk factor for hepatotoxicity in HIV-positive patients receiving combination antiretroviral therapy (cART), specific variables that may be predictive of severe hepatotoxicity among co-infected patients receiving cART remain poorly...

  • VIRUS DE LA HEPATITIS B E INFECCIÓN POR VIH/SIDA EN NIÑOS. SÁNCHEZ-PÉREZ, MAIRA PATRICIA // Revista Gastrohnup;2012, Vol. 14 Issue 2, p66 

    HIV/AIDS in children has increased worldwide and in our environment is no exception, although for many years has changed the natural history of disease using highly effective antiretroviral therapy (HAART). The most frequent way of transmission of Hepatitis B Virus (HBV) is contact with blood or...

  • Prevalence and characteristics of hepatitis B and C virus infections in treatment-naïve HIV-infected patients. Reuter, Stefan; Oette, Mark; Wilhelm, Frank; Beggel, Bastian; Kaiser, Rolf; Balduin, Melanie; Schweitzer, Finja; Verheyen, Jens; Adams, Ortwin; Lengauer, Thomas; Fätkenheuer, Gerd; Pfister, Herbert; Häussinger, Dieter // Medical Microbiology & Immunology;Feb2011, Vol. 200 Issue 1, p39 

    In HIV-infected treatment-naïve patients, we analyzed risk factors for either chronic hepatitis B (HBV) infection, occult HBV infection (OHBV) or a positive hepatitis C (HCV) serostatus. A total of 918 patients of the RESINA-cohort in Germany were included in this study. Before initiating...

  • Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras. Klein, Marina B.; Althoff, Keri N.; Yuezhou Jing; Lau, Bryan; Kitahata, Mari; Lo Re III, Vincent; Kirk, Gregory D.; Hull, Mark; Kim, H. Nina; Sebastiani, Giada; Moodie, Erica E. M.; Silverberg, Michael J.; Sterling, Timothy R.; Thorne, Jennifer E.; Cescon, Angela; Napravnik, Sonia; Eron, Joe; Gill, M. John; Justice, Amy; Peters, Marion G. // Clinical Infectious Diseases;11/1/2016, Vol. 63 Issue 9, p1160 

    Background. Human immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown. Methods. Twelve clinical cohorts in the United...

  • Antiretroviral Medication Considerations for Individuals Coinfected with HIV and Hepatitis C Virus. Lai, Andrew R.; Tashima, Karen T.; Taylor, Lynn E. // AIDS Patient Care & STDs;Oct2006, Vol. 20 Issue 10, p678 

    There is great need to treat HIV/hepatitis C virus (HCV)-coinfected individuals with both antiretroviral and anti-HCV pharmacotherapy. However, treatment for HIV may lead to hepatotoxicity, and there are potential interactions and synergistic effects between antiretrovirals and anti-HCV...

  • Hepatotoxicity of Antiretrovirals: Incidence, Mechanisms and Management. Núñez, Marina; Soriano, Vincent // Drug Safety;2005, Vol. 28 Issue 1, p53 

    Hepatotoxicity is a relevant adverse effect derived from the use of antiretrovirals that may increase the morbidity and mortality among treated HIV-infected patients and challenges the treatment of HIV infection. Although several antiretrovirals have been reported to cause fatal acute hepatitis,...

  • Reactivation of latent hepatitis B virus infection with HIV-related immunosuppression. Clark, S. J.; Creighton, S.; Horner, M.; Smith, H. M.; Portmann, B.; Taylor, C.; Cramp, M. E. // International Journal of STD & AIDS;Jan2006, Vol. 17 Issue 1, p67 

    The effect of HIV-related immunosuppression and antiretroviral therapy on the reactivation of latent hepatitis B virus (HBV) infection is unclear. We report four patients with advanced HIV-related immunosuppression and abnormal liver function tests who had evidence of HBV reactivation....

  • Liver Toxicity of Initial Antiretroviral Drug Regimens Including Two Nucleoside Analogs Plus One Non-Nucleoside Analog or One Ritonavir-Boosted Protease Inhibitor in HIV/HCV-Coinfected Patients. Macías, Juan; Neukam, Karin; Mallolas, Josep; López-Cortés, Luis F.; Cartón, José A.; Domingo, Pere; Moreno, Santiago; Iribarren, José A.; Clotet, Bonaventura; Crespo, Manell; de Los Santos, Ignacio; Ortega, Enrique; Knobel, Hernando; Jiménez-Expósito, María J.; Pineda, Juan A.; on behalf of the COINS Study Team*, Juan // HIV Clinical Trials (Thomas Land Publishers Incorporated);Mar/Apr2012, Vol. 13 Issue 2, p61 

    Objective: To evaluate the incidence and risk factors for grade 3 or 4 ALT or AST elevations (TE) and grade 4 total bilirubin elevations (TBE) among HIV/HCV- coinfected treatment-naïve patients with an initial regimen including 2 nucleoside analogs plus efavirenz (EFV), nevirapine (NVP), or a...

  • The impact of HBV or HCV infection in a cohort of HIV-infected pregnant women receiving a nevirapine-based antiretroviral regimen in Malawi. Andreotti, Mauro; Pirillo, Maria Franca; Liotta, Giuseppe; Jere, Haswell; Maulidi, Martin; Sagno, Jean-Baptiste; Luhanga, Richard; Amici, Roberta; Mancini, Maria Grazia; Gennaro, Elisabetta; Marazzi, Maria Cristina; Vella, Stefano; Giuliano, Marina; Palombi, Leonardo; Mancinelli, Sandro // BMC Infectious Diseases;2014, Vol. 14 Issue 1, p1 

    Background Coinfection with the hepatitis viruses is common in the HIV population in sub-Saharan Africa. The aim of this study was to assess, in a cohort of HIV-infected pregnant women receiving antiretroviral drugs (ARVs), the prevalence of HBV and HCV infections and to determine the impact of...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics