[Safety of atazanavir in patients with HIV and hepatitis B and/or C virus coinfection].
Atazanavir is a protease inhibitor indicated, in combination with other antiretrovirals, as an initial treatment of HIV infection or in previously treated patients. Antiretroviral treatment based on atazanavir has been associated with a low incidence of hepatotoxicity, both in Clinical Trials as well as in cohort studies. However, the finding of hyperbilirubinaemia has been common in these studies, although it usually does not involve withdrawing the treatment. In patients co-infected with hepatitis B or C, the level of virological response to does not appear to be affected and the incidence of adverse effects, except the higher incidence of hepatotoxicity, is no higher than in non-coinfected subjects. The incidence of severe hepatotoxicity (grade 3-4) in patients coinfected by HIV and HVC who receive drug combinations that contain atazanavir is 6%. Atazanavir has a favourable tolerance and safety profile in patients coinfected with hepatitis virus even in the presence of significant fibrosis. The lower association of atazanavir with the development of insulin resistance, a fact that has been associated with increasing the progression to hepatic fibrosis and lower treatment response rates, could be an added benefit of the use atazanavir in coinfected patients and could serve as an additional argument for its use in these 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
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000378:metabolism; D019701:Hepatitis D, Chronic / Q000150:complications / Q000378:metabolism; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced*; D007333:Insulin Resistance; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate