home





























 

















 





















hrsa

participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Hepatotoxicity Development During Antiretroviral Therapy Containing Protease Inhibitors in Patients with HIV [Aceti A et al. JAIDS 2002;29:41] This is a report from the "LIVERHAART Group" from Rome who reviewed the experience with 1,325 HIV-infected patients who received PI-based HAART for at least six months. The purpose was to determine the frequency of hepatotoxicity, which was categorized as mild (ALT elevated and less than 5 times upper limit of normal) or severe (ALT over 5 times upper limit of normal). The results showed that chronic HCV infection and alcohol abuse were strongly associated with hepatotoxicity. Among the PIs, ritonavir was associated with the highest rates of severe hepatotoxicity when it was used alone or in combination with saquinavir. The results are shown in the following table:

 

No.
 Total
> ULN
Severe
> 5x ULN
Ritonavir
120
 21 (17.5%)
14 (11.7%)
Saquinavir
372
 47 (12.6%)
14 (3.7%)
Indinavir
680
 58 (8.5%)
9 (1.3%)
Nelfinavir
88
 10 (11.4%)
0 (0%)
RTV/SQV
60
 11 (18.3%)
7 (11.6%)

Comment: Prior reports by Sulkowski and colleagues also showed a risk of hepatotoxicity that seemed to be substantially higher with ritonavir, but failed to show a strong correlation with chronic hepatitis. An explanation for the association with PIs in the presence of chronic viral hepatitis has been the possibility of immune reconstitution with immune-mediated hepatitis. The results here do not support this thesis because those with hepatotoxicity generally had poor HIV virologic response.
posted 2/08/2002





Copyright © 2001-2002. The National AIDS Education and Training Centers Program on behalf of its AETC National Resource Center. All rights reserved.

Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained in this site because no single reference or service can take the place of medical training, education, and experience. Consumers are cautioned that this site is not intended to provide medical advice about any specific medical condition they may have or treatment they may need, and they are encouraged to call or see their physician or other health care provider promptly with any health related questions they may have.