Clinical outcomes of first antiretroviral regimen in HIV/hepatitis C virus co-infection.
OBJECTIVE
Despite the benefits of HAART, initiation of antiretroviral therapy in HIV-HCV co-infected patients is often delayed as a consequence of patient and physician concern pertaining to liver toxicity. It is unclear whether this is justified.


METHODS
We retrospectively evaluated treatment duration and outcome in 186 patients initiating a first HAART regimen.


RESULTS
Despite frequent HIV RNA suppression and CD4 T-cell increase following initiation of HAART, the median duration of therapy was only 8 months. Therapy was discontinued primarily for gastrointestinal intolerance (26%), poor adherence (19%), neurocognitive side effects (13%), and substance abuse (6%). Regimes were changed to reduce pill burden and/or frequency of dosing as well (11%). Only six (4%) subjects interrupted therapy as a result of clinically apparent liver toxicity. None were on low dose ritonavir-containing therapy. In those subjects remaining on HAART for at least 12 months, the median ALT level increased marginally from a baseline of 44 IU/mL to 56 IU/mL. The median AST was 44 IU/mL at baseline and at month 12.


CONCLUSIONS
These results support our contention that regimen potency, durability, and extrahepatic side effect profile should remain the paramount considerations related to the selection of HAART regimen in HIV-HCV co-infection.
Cooper
C L
CL
Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, Canada. ccooper@ottawahospital.on.ca
Breau
C
C
Laroche
A
A
Lee
C
C
Garber
G
G
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019380:Anti-HIV Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury; D004334:Drug Administration Schedule; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000201:enzymology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase