title: Effect of antiretroviral drugs on liver fibrosis in HIV-infected patients with chronic hepatitis C: harmful impact of nevirapine.
abstract: BACKGROUND
  The hepatotoxicity of highly active antiretroviral therapy (HAART) could enhance liver fibrosis in HIV/Hepatitis C virus (HCV)-coinfected patients. Moreover, HAART-related immune restoration could lessen HCV-associated liver damage. The data on the effect of protease inhibitors (PI) on liver fibrosis are scant and contradictory. No information is available on the relationship between non-nucleoside analogue therapy and liver fibrosis in co-infected patients.
  
  
  OBJECTIVE
  To investigate the associations between the use of different antiretroviral drugs and the liver fibrosis in patients with HIV and HCV infections.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All HIV/HCV co-infected patients with an available liver biopsy and known or estimated duration of HCV infection seen at a Infectious Diseases Unit were included in the study. The fibrosis stage and the fibrosis progression rate were evaluated.
  
  
  RESULTS
  The inclusion criteria were fulfilled by 152 patients. Age at HCV infection < 20 years [adjusted odds ratio (AOR), 0.39; 95% confidence interval (CI), 0.19-0.82], PI-based HAART (AOR, 0.39; 95% CI, 0.19-0.78) and nevirapine-based HAART (AOR, 2.56; 95% CI, 1.02-6.58) were associated with fibrosis stage >or= F3. The variables associated with fibrosis progression rate > 0.2 units/year were age at HCV infection < 20 years (AOR, 0.23; 95% CI, 0.1-0.52), CD4 cell counts < or = 250 x 10/l at liver biopsy (AOR, 2.8; 95% CI, 1.1-7.1), PI-based HAART (AOR, 0.39; 95% CI, 0.2-0.8) and nevirapine-based HAART (AOR, 3.82; 95% CI, 1.9-7.6).
  
  
  CONCLUSIONS
  HAART regimens including nevirapine are associated with faster liver fibrosis progression in HIV-infected patients with chronic hepatitis C. In contrast, patients on PI as the backbone of potent antiretroviral therapy are more likely to show less liver fibrosis.
authors.affiliation: Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: Victor
authors.initials: V
authors.lastname: Castellano
authors.forename: Nicolás
authors.initials: N
authors.lastname: Merchante
authors.forename: Rosa B
authors.initials: RB
authors.lastname: Palacios
authors.forename: José A
authors.initials: JA
authors.lastname: Mira
authors.forename: Carmen
authors.initials: C
authors.lastname: Sáez
authors.forename: José A
authors.initials: JA
authors.lastname: García-García
authors.forename: Fernando
authors.initials: F
authors.lastname: Lozano
authors.forename: Jesús M
authors.initials: JM
authors.lastname: Gómez-Mateos
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D015497:HIV-1; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D019829:Nevirapine