Influence of viral chronic hepatitis co-infection on plasma drug concentrations and liver transaminase elevations upon therapy switch in HIV-positive patients.
It is still controversial whether viral hepatitis co-infection can influence antiretroviral plasma drug concentrations and whether drug concentrations are correlated with liver enzyme elevations during highly active antiretroviral therapy. An analysis of data from a cohort of 220 human immunodeficiency virus (HIV)-infected patients was conducted. Univariate and multivariate logistic analyses were performed to identify predictors of plasma drug concentrations. The association of transaminase elevation with higher plasma drug concentrations was explored following stratification of patients into HIV monoinfected and hepatitis C virus (HCV) and/or hepatitis B virus (HBV) co-infected groups. Hepatitis co-infections were independently correlated with drug concentrations above the therapeutic cut-offs at Week 1 (P=0.06), Week 4 (P=0.04) and Week 12 (P=0.005). The apparent effect was independent of the possible impact exerted by other variables such as demographics and medication adherence. The incidence of relevant hypertransaminasaemia was low. Patients with hepatitis co-infections had higher rates of transaminase elevation than monoinfected HIV patients; however, risk of transaminase elevation was not associated with drug concentrations. The presence of HCV and/or HBV co-infections correlated with higher plasma drug concentrations, although it did not appear to influence hepatotoxicity risk.
Torti
Carlo
C
Institute for Infectious and Tropical Diseases, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy. torti.carlo@libero.it
Lapadula
Giuseppe
G
Uccelli
Maria Cristina
MC
Quiros-Roldan
Eugenia
E
Regazzi
Mario
M
Ladisa
Nicoletta
N
Micheli
Valeria
V
Orani
Anna
A
Patroni
Andrea
A
Caputo
Sergio Lo
SL
Tirelli
Valeria
V
Di Giambenedetto
Simona
S
Cologni
Giuliana
G
Costarelli
Silvia
S
Gargiulo
Franco
F
Manca
Nino
N
Carosi
Giampiero
G
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D019380:Anti-HIV Agents / Q000097:blood*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D019694:Hepatitis B, Chronic / Q000150:complications / Q000378:metabolism*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000378:metabolism*; D006801:Humans; D008099:Liver / Q000187:drug effects*; D008297:Male; D008875:Middle Aged
D019380:Anti-HIV Agents; D000410:Alanine Transaminase