title: Antiretroviral hepatotoxicity in human immunodeficiency virus-infected patients.
abstract: BACKGROUND
  Drug hepatotoxicity is a potentially serious adverse reaction of antiretroviral therapy in human immunodeficiency virus-infected patients. The impact of this problem in the routine treatment of patients with human immunodeficiency virus infection is poorly defined.
  
  
  OBJECTIVE
  Our aim was to determine what clinical features are associated with hepatotoxicity in human immunodeficiency virus-infected patients receiving antiretroviral therapy.
  
  
  METHODS
  Consecutive patients in a primary care-based human immunodeficiency virus clinic were evaluated for hepatotoxicity. Clinic records were used to obtain patient characteristics, as well as independent variables including CD4+ count, coexisting hepatitis C and current alcohol use.
  
  
  RESULTS
  Sixty-five patients taking antiretroviral therapy were evaluated. Twenty-four were identified to have antiretroviral hepatotoxicity. An age over 40 years (P=0.019), an absolute CD4+ count of less than 310 cells/mL (P=0.002) and coexisting hepatitis C infection (P=0.035) were significantly associated with hepatotoxicity. Patients older than 40 years had a sevenfold increased risk (risk ratio, 6.9; 95% confidence interval, 1.7-27.3) and those with an absolute CD4+ count of less than 310 cells/mL had a tenfold increased risk (risk ratio, 10.2; 95% confidence interval, 2.5-41.9) for antiretroviral hepatotoxicity, in comparison with those who were younger or who had a greater absolute CD4+ count. Of the eight patients documented to have coexisting hepatitis C infection, six (75%) were in the antiretroviral hepatotoxicity group.
  
  
  CONCLUSIONS
  An age older than 40 years and an absolute CD4+ count of less than 310 cells/mL were significantly associated with antiretroviral-induced hepatotoxicity. The majority of our patients with chronic hepatitis C had hepatotoxicity from antiretroviral therapy.
authors.affiliation: Division of Gastroenterology, Section of Liver Diseases, University of Wisconsin Medical School, 945 N. 12th Street, Milwaukee, WI 53233, USA. vindinz@aol.com
authors.forename: L V
authors.initials: LV
authors.lastname: Hernandez
authors.forename: I
authors.initials: I
authors.lastname: Gilson
authors.forename: J
authors.initials: J
authors.lastname: Jacobson
authors.forename: A
authors.initials: A
authors.lastname: Affi
authors.forename: T R
authors.initials: TR
authors.lastname: Puetz
authors.forename: V J
authors.initials: VJ
authors.lastname: Dindzans
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019380:Anti-HIV Agents / Q000009:adverse effects*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008099:Liver / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; D018894:Reverse Transcriptase Inhibitors; D000410:Alanine Transaminase