Risk of Liver Enzyme Elevation During Treatment With Ritonavir-Boosted Protease Inhibitors Among HIV-Monoinfected and HIV/HCV-Coinfected Patients.
BACKGROUND
The risk of liver enzyme elevation (LEE) after different ritonavir-boosted protease inhibitors (PI/r) has not been fully assessed in real-life settings and in populations with high rates of hepatitis C virus (HCV) coinfection.


METHODS
Patients introducing a new PI/r between 1998 and 2012 were included, if transaminases and HCV antibody (Ab) were assessed before treatment initiation. Time to grade 3 and 4 LEE were assessed using univariable and multivariable conditional Cox analyses, stratified by HCV serostatus.


RESULTS
A total of 6193 HIV-infected patients (3242 HCV-Ab negative and 2951 HCV-Ab positive) were included. Incidence of grade 3 LEE was 1.05, 7.66, and 8.08 per 100 patient-years of follow-up among HCV-Ab negative, HCV-Ab-positive and HCV-RNA-positive patients, respectively. Among HCV-Ab-negative patients, no differences were detected between different PI/r. Use of darunavir/ritonavir was not associated with LEE among HCV-coinfected patients. Atazanavir/ritonavir use was associated with grade 3 LEE but only among HCV-Ab-positive patients (versus LPV/r, hazard ratio: 1.39; 95% confidence interval: 1.1 to 1.75). This risk was not confirmed in a subanalysis restricted to HCV-RNA-positive patients (versus LPV/r, hazard ratio: 1.16; 95% confidence interval: 0.87 to 1.55). Other independent predictors of grade 3 LEE among HCV-Ab-positive patients were older age, male gender, being treatment naive, nonnucleoside reverse transcriptase inhibitor coadministration, increased aspartate aminotransferase at baseline, overweight, positive HCV-RNA, and advanced estimated liver fibrosis.


CONCLUSIONS
Occurrence of hepatotoxicity was a rare finding among HCV-Ab-negative patients and was not influenced by the type of PI/r. In particular, the use of darunavir/ritonavir, previously linked with severe cases of hepatotoxicity, was not associated with a greater risk of LEE, irrespective from HCV serostatus.
*Clinic of Infectious Diseases, AO "San Gerardo de' Tintori," Monza, Italy; †IRCCS Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy; ‡University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy; §Clinic of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy; ‖Clinic of Infectious Diseases, "Sacro Cuore" Catholic University, Rome, Italy; ¶Clinic of Infectious Diseases, Ospedale Sant'Anna, Ferrara, Italy; #Clinic of Infectious Diseases, Ospedale Policlinico, Bari, Italy; **Clinic of Infectious Diseases, Ospedale S.M. Annunziata, Florence, Italy; ††Clinic of Infectious Diseases, Istituti Ospitalieri, Cremona, Italy; ‡‡Clinic of Infectious Diseases, Spedali Civili, Brescia, Italy; and §§Department of Surgical and Medical Sciences, University "Magna Graecia," Catanzaro, Italy.
Giuseppe
G
Lapadula
Silvia
S
Costarelli
Liliane
L
Chatenoud
Francesco
F
Castelli
Noemi
N
Astuti
Simona
S
Di Giambenedetto
Eugenia
E
Quiros-Roldan
Laura
L
Sighinolfi
Nicoletta
N
Ladisa
Massimo
M
Di Pietro
Alessia
A
Zoncada
Elisa
E
Di Filippo
Andrea
A
Gori
Paola
P
Nasta
Carlo
C
Torti
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007558:Italy; D008099:Liver / Q000187:drug effects / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D019438:Ritonavir