title: A switch to Raltegravir improves antiretroviral associated hepatotoxicity in individuals co-infected with HIV and hepatitis C.
abstract: BACKGROUND
  Raltegravir is a switch option for HIV/HCV co-infected individuals due to its hepatic neutral profile. We evaluated the effect of a switch to Raltegravir from other antiretroviral agents in HIV and HCV-co-infected individuals naïve to HCV therapy.
  
  
  METHODS
  Observational, single-centre study. Data on alanine aminotransferase levels, HCV-VL, CD4 cell count, HIV viral load levels and hepatic fibrosis score were collated six months pre-switch, at the time of switch and six months post switch to Raltegravir therapy. Results were compared utilizing the Kruskal-Wallis test.
  
  
  RESULTS
  Twenty-seven individuals were identified. Median age was 43 years, median duration of HIV infection was 7 years and median documented period of HCV infection at the time of switch was 26 months. A sustained improvement in ALT levels was observed. Median ALT levels were 254 IU/L at the time of switch, decreasing significantly to 176 IU/L, (p = 0.0226) and 90 IU/L (p = 0.0138) 1 month post switch and 6 months post switch respectively. The median Hepatitis C viral load level at the time of the switch was 341,783 copies/mL, which decreased to 224,066 copies/mL 6 months after switch (p = 0.04).
  
  
  CONCLUSIONS
  A switch to Raltegravir in individuals with HIV/HCV co-infection was effective in maintaining HIV virological suppression with improvement in drug-associated hepatotoxicity as measured by ALT.
authors.affiliation: Chelsea and Westminster Hospital, HIV/GUM Department, London, UK. Electronic address: muge.cevik@nhs.net.
authors.forename: M
authors.initials: M
authors.lastname: Cevik
authors.affiliation: Chelsea and Westminster Hospital, HIV/GUM Department, London, UK; Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Katsarolis
authors.affiliation: Chelsea and Westminster Hospital, HIV/GUM Department, London, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Singh
authors.affiliation: Chelsea and Westminster Hospital, HIV/GUM Department, London, UK; Imperial College School of Medicine, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy*; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011760:Pyrrolidinones / Q000627:therapeutic use*; D000068898:Raltegravir Potassium; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D011760:Pyrrolidinones; D000068898:Raltegravir Potassium; D000410:Alanine Transaminase
keywords: Co-infection; Enzyme elevations; HIV; Hepatitis; Hepatitis C; Hepatotoxicity; Liver; Raltegravir; cART