Risk factors for acute liver enzyme abnormalities in HIV-hepatitis B virus-coinfected patients on antiretroviral therapy.
BACKGROUND
Little is known about the prognostic factors of acute liver enzyme variations in HIV-hepatitis B virus (HBV)-coinfected patients.


OBJECTIVE
To identify prognostic factors of acute liver enzyme abnormalities in HIV-HBV-coinfected patients with a focus on the putative role of antiretroviral drugs.


METHODS
Data from a 3-year, prospective, multicentre cohort study involving HIV-HBV patients were used.


METHODS
A Markov model was used to identify prognostic factors of acute episodes of cytolysis and cholestasis in 300 HIV-HBV-coinfected patients. The effect of antiretroviral therapy was analysed according to the classes of drugs, duration of treatment and treatment modifications.


RESULTS
The incidence rates of acute episodes of cytolysis and cholestasis were 13.4 per 100 patient-years (95% confidence interval [CI] 9.5-17.3) and 7.1 per 100 patient-years (95% CI 4.2-10.0), respectively (median follow up 34.1 months). Independent risk factors for cytolysis were a high level of HBV or HIV replication, as well as a low of CD4+ T-cell count. No antiretroviral drug was associated with cytolysis, whereas protease inhibitors seemed to be independently associated with cholestasis, along with treatment modifications and the duration of HIV infection.


CONCLUSIONS
Acute and reversible episodes of cytolysis or cholestasis were common and associated with virus- and host-related determinants. The choice of the optimal antiretroviral combination in HIV-HBV-coinfected patients must take into account the necessity of exerting an efficient control of HIV and HBV replication (associated with transient cytolysis) and the risk of inducing cholestasis (associated with the use of protease inhibitors and treatment modifications).
Chauvel
Olivia
O
AP-HP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France.
Lacombe
Karine
K
Bonnard
Philippe
P
Lascoux-Combe
Caroline
C
Molina
Jean-Michel
JM
Miailhes
Patrick
P
Girard
Pierre-Marie
PM
Carrat
Fabrice
F
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D002779:Cholestasis / Q000209:etiology*; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008099:Liver / Q000201:enzymology; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019562:Viral Load