Hepatotoxicity of Antiretroviral Drugs Is Reduced after Successful Treatment of Chronic Hepatitis C in HIV‐Infected Patients
1Department of Infectious Diseases, Hospital Carlos III, Madrid, and 2HIV Unit, Hospital San Millán, Logroño, Spain
Background.
The risk of liver toxicity during antiretroviral drug use in human immunodeficiency virus (HIV)–positive patients increases in the presence of chronic hepatitis C virus (HCV) infection. It is unknown whether sustained HCV clearance after interferon (IFN)–based therapy might reduce this complication.
Methods.The incidence of severe elevations in liver enzyme levels during antiretroviral therapy was retrospectively analyzed in a group of HIV/HCV‐coinfected patients after completion of a full course of IFN‐based therapy. Hepatic events were recorded according to the achievement of a sustained virological response (SVR), and the presence of advanced liver fibrosis was assessed by transient elastometry.
Results.A total of 132 HIV/HCV‐coinfected patients were analyzed (66% men; mean age, 38 years). Overall, 33% achieved an SVR and 40% had advanced liver fibrosis after IFN therapy. A total of 49 episodes of liver toxicity occurred during a mean of 35 months of follow‐up (9.7% per year) after IFN therapy. The yearly incidence of hepatic events was greater in patients who did not achieve an SVR than in those who did (12.9% vs. 3.1%; 
) and in patients with advanced liver fibrosis than in those without it (14.4% vs. 7.6%; 
). Drugs involved in hepatic events were dydeoxynucleoside analogues (namely, didanosine and stavudine; 40%) nevirapine (30%), efavirenz (11%), and protease inhibitors (PIs; 8%). In logistic regression analysis, lack of an SVR (odds ratio [OR], 6.13 [95% confidence interval {CI}, 1.83–37.45]; 
) and the use of dydeoxynucleosides (OR, 3.59 [95% CI, 1.23–10.42]; 
) were independent predictors of hepatotoxicity after IFN therapy. Conversely, regimens containing PIs (OR, 0.07 [95% CI, 0.02–0.30]; 
) or efavirenz (OR, 0.13 [95% CI, 0.04–0.44]; 
) were associated with a diminished risk of hepatic events.
Conclusion.Sustained HCV clearance after IFN‐based therapy reduces the risk of liver toxicity during antiretroviral therapy, which should further encourage the treatment of chronic hepatitis C in HIV‐coinfected patients. In this population, prescription of PIs or efavirenz decreases and use of dydeoxynucleoside analogues increases the risk of hepatotoxicity.
Received 2 January 2007; accepted 14 February 2007; electronically published 13 July 2007.
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(See the editorial commentary by Cooper, on pages 656–8.)
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Potential conflicts of interest: none reported.
Financial support: Fundación Investigación y Educación en SIDA; Red de Investigación en SIDA; European Network for Vigilance against Viral Resistance; Fondo de Investigaciones Sanitarias; Agencia Lain Entralgo.