HAART and liver: is it safe?
BACKGROUND
Liver disease caused by hepatitis C virus (HCV) is a major cause of morbidity in HIV patients. This study investigates the possibility that chronic HCV increases the risk of hepatotoxicity after highly active antiretroviral therapy (HAART) initiation.


METHODS
The data from 30 coinfected HIV/HCV and 35 HIV monoinfected patients between August 2008 and August 2010, since the start of HAART, were analyzed along with data from every three months, with clinical/laboratory evaluation until the end of twelve months. The aim of this study was to assess risk and incidence of hepatotoxicity in both groups.


RESULTS
Before the introduction of HAART, coinfected patients had higher average levels of transaminases than did the monoinfected group (p < 0.001). After initiation of HAART, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in coinfected patients, regardless of type of HAART they received. Twenty-two (73%) of the coinfected patients had some degree of hepatotoxicity versus only seven (20%) of the monoinfected patients. No patient had severe hepatotoxicity. Risk of hepatotoxicity after HAART in a coinfected patient was 3.7 times higher than in a monoinfected patient (RR 3.7 [1.8-7.4], p < 0.001).


CONCLUSIONS
This study demonstrates that coinfected patients are at an increased risk for developing hepatotoxicity, but the clinical and immunological benefits of HAART are higher than the risk of hepatotoxicity and rarely justify discontinuation of therapy.
Hospital Fêmina, Porto Alegre, RS, Brasil. vicente_antonello@hotmail.com.
Vicente Sperb
VS
Antonello
Dimas Alexandre
DA
Kliemann
Breno
B
Rigel Santos
Cristiane Valle
CV
Tovo
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment
D044966:Anti-Retroviral Agents