Antiretroviral therapy-related hepatotoxicity: predictors and clinical management.
Severe hepatotoxicity develops in 5-10% of people with HIV infection in the first 12 months following initiation of highly-active antiretroviral therapy (HAART), with continuing risk in subsequent years. The major risk factors for severe hepatotoxicity are underlying chronic viral hepatitis, abnormal baseline levels of serum hepatic transaminases, and nevirapine or high-dose ritonavir-containing antiretroviral therapy regimens. The vast majority of severe hepatotoxicity cases are not associated with development of symptoms of acute hepatitis or other adverse hepatic outcomes and resolve within a few months. Antiretroviral therapy should be discontinued in association with grade 4 elevations in serum hepatic transaminase measurements, hyperlactataemia, symptoms of acute hepatitis, or features of drug hypersensitivity.
Dore
Greg
G
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria Street, Sydney, NSW 2010, Australia.
D000410:Alanine Transaminase / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury; D006678:HIV / Q000254:growth & development* / Q000378:metabolism; D015658:HIV Infections / Q000188:drug therapy* / Q000201:enzymology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D016174:Hepacivirus / Q000254:growth & development; D006515:Hepatitis B virus / Q000254:growth & development; D006801:Humans; D008107:Liver Diseases / Q000201:enzymology / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors
D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase