[Darunavir in HIV/HVC/HVB coinfection].
Darunavir/ritonavir is indicated in combination with other antiretroviral drugs for the treatment of HIV-1 infection in pre-treated adult patients. In hepatitis B or C co-infected patients, the virological response rate to darunavir/ritonavir appeared to be unaffected and, except for increased liver enzymes, the incidence of adverse events was not higher than in patients without co-infection. Drug-induced hepatitis has been reported in 0.5% of patients receiving combination therapy with darunavir/ritonavir. Patients with pre-existing liver dysfunction, including chronic active hepatitis B or C, have an increased risk for liver function abnormalities including severe hepatic adverse events. Therefore AST/ALT monitoring should be considered in patients with underlying chronic hepatitis, (HVB/HCV) like it is recommended in all patients receiving boosted PIS. Darunavir is primarily metabolized by the liver. The steady-state pharmacokinetic parameters of darunavir are similar in patients with normal liver function, mild hepatic impairment (Child-Pugh Class A), and moderate hepatic impairment (Child-Pugh Class B). The effect of severe hepatic impairment on the pharmacokinetics of darunavir has not been evaluated. No dose adjustment is required in patients with mild or moderate hepatic impairment. There are no data on the use of darunavir in patients with severe hepatic impairment and consequently this drug is not recommended in this group of patients.
Rivero
Antonio
A
Unidad de Gestión Clínica de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba. España. ariveror@gmail.com
Camacho
Angela
A
Pérez-Camacho
Inés
I
Torre-Cisneros
Julián
J
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D017322:Clinical Trials, Phase II as Topic / Q000706:statistics & numerical data; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D000069454:Darunavir; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015497:HIV-1; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000378:metabolism; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D008658:Inactivation, Metabolic; D008099:Liver / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
D000998:Antiviral Agents; D017320:HIV Protease Inhibitors; D013449:Sulfonamides; D000069454:Darunavir