Phillips, E.

Raboud, J.

Saskin, R.

English

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5th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV A RETROSPECTIVE COHORT STUDY OF LIVER TOXICITY INHEPATITIS B AND C HIV CO-INFECTED PATIENTS IN THE HIVONTARIO OBSERVATIONAL DATABASE  E Phillips1,2, J Raboud2,3 and R Saskin3 1Sunnybrook and Women's College Hospital; 2University Health Network; and 3MountSinai Hospital, University of Toronto, Toronto, ON, Canada Antiviral Therapy 2003; 8:L84 (abstract 127)  July 8, 2003  OBJECTIVES: To identify risk factors for significant hepatic dysfunction amongHIV/hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infected patients related toantiretroviral (ART) exposure.METHODS: All HIV Ontario Observational Database (HOOD) patients that werechronic carriers of HBV or HCV were identified. ART medication and laboratoryadverse event data were obtained through bi-annual chart reviews.RESULTS: Four-hundred-and-four HIV-positive patients were identified as co-infectedwith HCV (n=317), HBV (n=104) or both HCV and HBV (n=17). Two hundred and forty-three (60%) and 249 (62%) of these patients had ever had grade 3 or 4 elevations inalanine aminotransferase (ALT) and aspartate aminotransferase (AST), respectively,versus 676 (41%) and 673 (41%) (P<0.001 and P<0.001) of those with HIV not co-infected. The median [interquartile range (IQR)] duration of infection with HCV and/orHBV at the time of initial identification of elevations in transaminases (AST/ALT) was842 days (260–1780). The median (IQR) time after starting any ART to thedevelopment of grade 3 or 4 hepatic dysfunction was 896 days (216–1680). Grade 3 or4 elevations in AST/ALT were significantly associated with ever taking: a boostedprotease inhibitor (PI) (72% vs 59%, P=0.01), ritonavir (70% vs 51%, P=0.0001) and/ordidanosine (ddI) (66% vs 56%, P=0.03), and a trend with ever taking stavudine (d4T)(63% vs 54%, P=0.06), but not with taking a nelfinavir-based regimen without previousexposure to ritonavir, d4T and/or ddI (61% vs 62%, P=0.96). Patients who had everhad grade 3 or 4 elevations in ALT/AST also had exposure to higher median numbersof all types of ARTs (6 vs 5, P<0.001), nucleoside reverse transcriptase inhibitors (4 vs3, P=0.001), non-nucleoside reverse transcriptase inhibitors (1 vs 0, P=0.004) and PIs(2 vs 1, P=0.002).CONCLUSION: A high proportion of HIV patients co-infected with HBV and HCV haveserious elevations in transaminases which may be related to both type and cumulativeexposure to ART. Patients exposed to boosted PI regimens, ddI and d4T appear to beat heightened risk, and patients on nelfinavir-based regimens without previousexposure to other PIs or ddI/d4T at lower risk, for serious hepatotoxicity.Presenting author: E Phillips  www.aegis.org

A retrospective cohort study of liver toxicity in hepatitis B and C HIV co-infected patients in the HIV Ontario Observational Database

http://researchrepository.murdoch.edu.au/16191/

A retrospective cohort study of liver toxicity in hepatitis B and C HIV co-infected patients in the HIV Ontario Observational Database

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