alexa Liver toxicity of initial antiretroviral drug regimens including two nucleoside analogs plus one non-nucleoside analog or one ritonavir-boosted protease inhibitor in HIV HCV-coinfected patients.
Infectious Diseases

Infectious Diseases

Journal of AIDS & Clinical Research

Author(s): Macas J, Neukam K, Mallolas J, LpezCorts LF, Cartn JA, , Macas J, Neukam K, Mallolas J, LpezCorts LF, Cartn JA,

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Abstract OBJECTIVE: To evaluate the incidence and risk factors for grade 3 or 4 ALT or AST elevations (TE) and grade 4 total bilirubin elevations (TBE) among HIV/HCV- coinfected treatment-naïve patients with an initial regimen including 2 nucleoside analogs plus efavirenz (EFV), nevirapine (NVP), or a ritonavir-boosted protease inhibitor (PI/r). PATIENTS AND METHODS: This was a retrospective multicenter observational cohort study that recruited 745 HIV-infected drug-naïve patients with detectable plasma HCV RNA who started a regimen including EFV, NVP, or PI/r. RESULTS: EFV was prescribed in 323 (43\%), NVP in 126 (17\%), and a PI/r in 296 (40\%) patients. Grade 3 or 4 TE were observed in 19 (5.9\%) individuals receiving EFV compared with 14 (11\%) on NVP (P = .056) and 31 (10.5\%) on PI/r (P = .036). Grade 4 TBE were identified in 7 (2.2\%) patients on EFV, 1 (0.8\%) on NVP, and 11 (3.7\%) on PI/r (P = .19). Therapy was discontinued due to liver toxicity in 13 (4\%) patients on EFV, 16 (13\%) on NVP, and 17 (6\%) on PI/r (P = .003). CONCLUSIONS: Regimens including EFV, NVP, or PI/r are generally safe in treatment-naïve HIV/HCV-coinfected patients. Grade 3-4 TE are less commonly seen with EFV than with PI/r. Discontinuations due to hepatotoxicity were less frequent for patients receiving EFV than for those treated with NVP. This article was published in HIV Clin Trials and referenced in Journal of AIDS & Clinical Research

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