Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon

Mbougua, Jules Brice Tchatchueng; Laurent, Christian; Kouanfack, Charles; Bourgeois, Anke; Ciaffi, Laura; Calmy, Alexandra; Gwet, Henri; Koulla‐Shiro, Sinata; Ducos, J; Mpoudi‐Ngolé, Eitel; Molinari, Nicolas; Delaporte, Eric

doi:10.1186/1471-2458-10-105

Cited by 29 publications

(25 citation statements)

References 30 publications

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“…Lower results were also found in a study conducted in Tanzania which found 0.3% severe hepatotoxicity [1] while a higher prevalence of 7% was found in a study done in Cameroon in mono-infected patients [18]. This difference from the Cameroon study could be due to different treatment regimens and different study designs.…”

Section: Discussionmentioning

confidence: 79%

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Shanyengana¹,

Mukesi²,

Colf³

et al. 2016

WJA

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Elevated alanine aminotransferase (ALT) levels in Human Immunodeficiency Virus (HIV) infected people is a major concern in the world and especially in Africa. It may lead to liver failure and even death. Certain antiretroviral (ARV) drugs, such as nevirapine and efavirenz, are known to cause toxicity. Other causes of elevated ALT are viral hepatitis, the HIV virus itself and other drugs such as anti-tu-berculosis drugs and alcoholism. The study aimed at determining the prevalence of elevated ALT levels in HIV positive patients on antiretroviral therapy during the period 2013 to 2014. This was a retrospective study which included 267 patient records from Katutura and Windhoek Central hospitals in Windhoek, Namibia. The subjects' ages ranged from 21 to 82 years. The patients enrolled were on the first line treatment and their ALT levels were recorded at each monitoring period. ALT levels, viral hepatitis results and the antiretroviral therapy (ART) regimen were the most important aspects included in the study. Out of 267 patients, 18% had ALT elevation associated with grade 1 to 4 toxicity levels. The study found that 1.4% of patients developed severe liver toxicity (grade 3 and 4 toxicity). Toxicity occurred throughout the treatment period but was the highest at six months of treatment. Patients on nevirapine based regimens had lower toxicity compared to those receiving efavirenz based regimens. Patients who had HIV and viral hepatitis co-infection had high toxicity although the study found no severe hepatotoxicity in these patients.

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Section: Discussionmentioning

confidence: 79%

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Shanyengana¹,

Mukesi²,

Colf³

et al. 2016

WJA

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“…Of the 48 independent cohorts, 31 reported results from the overall cohort [24, 62, 64–92], while 17 reported results from two different groups within the cohort [59, 93–108], although for two of these studies, only one group was considered in our meta-analysis due to sample size restriction [100, 107]. This gave 63 distinct populations.…”

Section: Resultsmentioning

confidence: 99%

Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis

et al. 2017

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BackgroundUNAIDS recently defined the 90-90-90 target as a way to end the HIV epidemic. However, the proportion of virological success following antiretroviral therapy (ART) may not be as high as the anticipated 90%, and may in fact be highly heterogeneous. We aimed to describe the proportion of virological success in sub-Saharan Africa and to identify factors associated with the proportion of virological success.MethodsWe performed a systematic review and meta-analysis focusing on the proportion of patients in sub-Saharan Africa who demonstrate virological success at 12 and 24 months since ART initiation, as well as at 6 and 36 months, where possible. Programme factors associated with the proportion of virological success were identified using meta-regression. Analyses were conducted using both on-treatment (OT) and intention-to-treat (ITT) approaches.ResultsEighty-five articles were included in the meta-analysis, corresponding to 125 independent study populations. Using an on-treatment approach, the proportions (95% confidence interval (CI)) of virological success at 12 (n = 64) and at 24 (n = 32) months since ART initiation were 87.7% (81.3–91.0) and 83.7% (79.8–87.6), respectively. Univariate analysis indicated that the proportion of virological success was not different by study design. Multivariate analysis at 24 months showed that the proportion of virological success was significantly larger in studies conducted in public sector sites than in other sites (p = 0.045). Using an ITT approach, the proportions (95% CI) of virological success at 12 (n = 50) and at 24 (n = 20) months were 65.4% (61.8–69.1) and 56.8% (51.3–62.4), respectively. At 12 months, multivariate analysis showed that the proportion of success was significantly lower in cohort studies than in trials (63.0% vs. 71.1%; p = 0.017). At 24 months, univariate analysis demonstrated that the proportion of success was also lower in cohorts.DiscussionRegardless of the time following ART initiation, and of the threshold, proportions of virological success were highly variable. Evidence from this review suggests that the new international target of 90% of patients controlled is not yet being achieved, and that in order to improve the virological outcome, efforts should be made to improve retention in care.

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“…6 However, nevirapine hepatotoxicity occurs at higher HIV CD4+ counts than those at which patients in sub-Saharan Africa begin ART, and safe use of nevirapine-based regimens has been suggested in patients where CD4 count is low irrespective of HBV and HCV co-infections. 7 …”

Section: Introductionmentioning

confidence: 99%

Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda

et al. 2010

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Summary Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20–164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting.

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Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon

Cited by 29 publications

References 30 publications

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis

Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda

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