Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection

Brinker, Marieke den; Wit, Ferdinand W. N. M.; Dillen, Pauline M. E. Wertheim-van; Jurriaans, Suzanne; Weel, Jan; Leeuwen, Remko van; Pakker, Nadine; Reiss, Peter; Danner, Sven A.; Weverling, Gerrit Jan; Lange, Joep M. A.

doi:10.1097/00002030-200012220-00011

Cited by 353 publications

(233 citation statements)

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“…Chronic hepatitis C or B virus infection, alcohol abuse or NAFLD may be present. However, as has been seen with highly active antiviral therapy for HIV, the hepatotoxicity of the drug appears to be augmented by the pre-existing hepatic infection/disorder [60][61][62][63].…”

Section: Discussionmentioning

confidence: 99%

Mitochondrial dysfunction and delayed hepatotoxicity: another lesson from troglitazone

Julie

Kende

et al. 2008

Diabetologia

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Section: Discussionmentioning

confidence: 99%

Mitochondrial dysfunction and delayed hepatotoxicity: another lesson from troglitazone

Julie

Kende

et al. 2008

Diabetologia

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“…These subjects show elevated alanine aminotransferase levels and are at a higher risk of developing fibrosis, cirrhosis, liver failure or hepatocellular carcinoma than subjects infected only with HCV 6 ; in addition, they show a higher risk of developing hepatic toxicity related to the use of highly active antiretroviral therapy than patients infected only with HIV 5,26 .…”

Section: Introductionmentioning

confidence: 99%

Serological, epidemiological and molecular aspects of hepatitis C virus infection in a population from Londrina, PR, Brazil, 2001-2002

Vogler

Nishiya

Morimoto

et al. 2004

Rev. Inst. Med. trop. S. Paulo

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SUMMARYSerological, epidemiological and molecular aspects of hepatitis C virus (HCV) infection were evaluated in 183 subjects from Londrina, Paraná, Brazil, and adjacent areas. Serum samples which tested anti-HCV positive by microparticle enzyme immunoassay (MEIA) obtained from eight patients with chronic hepatitis C, 48 blood donors, and 127 patients infected with the human immunodeficiency virus (HIV) were submitted to another enzyme immunoassay (ELISA) and to the polymerase chain reaction (PCR). About 78.7% of samples were also reactive by ELISA, with the greater proportion (70.8%) of discordant results verified among blood donors. A similar finding was observed for HCV-RNA detection by PCR, with 111/165 (67.3%) positive samples, with higher rates among HIV-positive subjects and patients with chronic hepatitis than among blood donors. Sixty-one PCRpositive samples were submitted to HCV genotyping, with 77.1, 21.3 and 1.6% of the samples identified as types 1, 3 and 2, respectively. Finally, analysis of some risk factors associated with HCV infection showed that intravenous drug use was the most common risk factor among HIV/HCV co-infected patients, while blood transfusion was the most important risk factor in the group without HIV infection. The present study contributed to the knowledge regarding risk factors associated with HCV infection and the distribution of HCV genotypes in the population evaluated. KEYWORDS:Hepatitis C virus; Anti-HCV; Genotypes; Epidemiology. INTRODUCTIONAbout 170 million people all over the world are infected with hepatitis C virus (HCV), although many ignore such fact 30 . In most cases, the infection develops as an asymptomatic clinical picture but with severe consequences, since about 80% of the infected subjects develop chronic hepatitis, cirrhosis or hepatocellular carcinoma 16,28 .Co-infection of HCV-infected subjects with the human immunodeficiency virus (HIV) has important implications for the prognosis and management of both diseases. These subjects show elevated alanine aminotransferase levels and are at a higher risk of developing fibrosis, cirrhosis, liver failure or hepatocellular carcinoma than subjects infected only with HCV 6 ; in addition, they show a higher risk of developing hepatic toxicity related to the use of highly active antiretroviral therapy than patients infected only with HIV 5,26 .The use of the polymerase chain reaction (PCR) for the detection of HCV-RNA allows the identification of the presence of active HCV infection. However, RNA levels may show fluctuations with nondetectable periods even in patients not submitted to interferon therapy 7 .Patient counseling regarding the risk-benefit of treatment also requires analysis of a liver biopsy and the determination of the HCV genotype. Differences in the response to treatment depending on the HCV genotype have been observed, with type 1 being more resistant than types 2 and 3 19 . Genotyping based on the amplification of the 5' untranslated region (5'-UTR) has the advantage that it can be performed on PCR ...

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“…1 However, in approximately 6% to 30% of treated patients, antiretroviral therapy is associated with significant increases in serum liver enzymes, which may require discontinuation of HIV treatment. [2][3][4][5][6] In addition, because of shared routes of transmission, chronic viral hepatitis is common, with an estimated 30% and 10% of HIV-infected persons coinfected with hepatitis C virus (HCV) and hepatitis B virus (HBV), respectively. [7][8][9] Consequently, hepatologists are frequently asked to evaluate HIVinfected patients with abnormal liver enzymes, and to assess the causal role of antiretroviral drugs and chronic viral hepatitis.…”

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confidence: 99%

“…2,3,5,[10][11][12] More recently, based on studies showing greater effectiveness and tolerability, HIV-infected patients are increasingly prescribed antiretroviral regimens, which include HIV-1-specific non-nucleoside analog reverse transcriptase inhibitors (NNRTIs), such as nevirapine (NVP) and efavirenz (EFV), instead of PIs. [13][14][15][16][17] In addition, the emergence of HIV-1 drug resistance among antiretroviral-experienced patients has led to the more frequent use of HAART, which includes both PIs and NNRTIs.…”

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confidence: 99%

Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: Role of hepatitis C and B infections

et al. 2002

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Hepatologists are frequently asked to evaluate human immunodeficiency virus (HIV)-infected patients with abnormal liver enzymes and to assess the causal role of medications, such as antiretroviral drugs. Recently, the use of HIV-1 specific non-nucleoside reverse transcriptase inhibitors (NNRTIs), including nevirapine (NVP) and efavirenz (EFV), has been associated with severe hepatic injury. We prospectively studied the incidence of severe hepatotoxicity (grade 3 or 4 change in alanine or aspartate transaminase levels) among 568 patients receiving NNRTI-containing antiretroviral therapy, including 312 and 256 patients prescribed EFV and NVP, respectively. Hepatitis C virus (HCV) and hepatitis B virus (HBV) were detected in 43% and 7.7% of patients, respectively. Severe hepatotoxicity was observed in 15.6% of patients prescribed NVP and 8.0% of those prescribed EFV, but only 32% of NVP and 50% of EFV-associated episodes were detected during the first 12-weeks of therapy. The risk was significantly greater among persons with chronic viral hepatitis (69% of cases) and those prescribed concurrent protease inhibitors (PIs) (82% of cases). Nonetheless, 84% of patients with chronic HCV or HBV did not experience severe hepatotoxicity. Severe hepatotoxicity occurs throughout the course of NNRTI therapy and is more common among patients prescribed nevirapine, those coinfected with HCV or HBV, and those coadministered protease inhibitors. (HEPATOLOGY 2002;35:182-189.)

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Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection

Abstract: HIV-1-infected patients co-infected with HBV or HCV were at considerably higher risk of developing LEE when HAART was initiated compared with patients without co-infection, but it is usually not necessary to modify antiretroviral therapy.

Cited by 353 publications

References 20 publications

Mitochondrial dysfunction and delayed hepatotoxicity: another lesson from troglitazone

Mitochondrial dysfunction and delayed hepatotoxicity: another lesson from troglitazone

Serological, epidemiological and molecular aspects of hepatitis C virus infection in a population from Londrina, PR, Brazil, 2001-2002

Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: Role of hepatitis C and B infections

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