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Mohammed O, Alemayehu E, Bisetegn H, Tilahun M, Gedefie A, Ebrahim E, Fiseha M, Necho M, Fiseha T. Prevalence of hepatotoxicity among HIV-infected patients in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:826. [DOI: 10.1186/s12879-022-07838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Globally, the human immunodeficiency virus has been recognized as a major public health concern. The direct toxicity of antiretroviral medicines or their active metabolites causes liver cell destruction by different mechanisms, inducing immune-mediated inflammation, oxidative stress, and other mechanisms. On the other hand, the virus itself also produces hepatotoxicity. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of hepatotoxicity among HIV-infected patients in Ethiopia.
Methods
PubMed, Science Direct, Cochrane Library, Web of Science, and ResearchGate databases were used to find relevant articles. As well, various professional associations were searched to retrieve grey literature. The Newcastle–Ottawa Quality Assessment Scale was used to assess the quality of recruited studies. The data were extracted using Microsoft Excel, and the meta-analysis was carried out using STATA 14 software. I2 and Cochran’s Q test were employed to assess the presence of heterogeneity between studies. A random effect model was used. The funnel plot and Egger’s statistics were used to assess publication bias. Moreover, subgroup analysis and sensitivity analysis were also done.
Results
The pooled prevalence of hepatotoxicity among HIV patients in Ethiopia was 25.45% (95% CI = 20.06–30.84%). There was high heterogeneity, with an I2 value of 93.7%. Subgroup analysis by HAART status showed a higher pooled prevalence of hepatotoxicity among HIV patients taking HAART (23.63%) than among HAART naive patients (7.29%). In subgroup analysis, the pooled prevalence of hepatotoxicity among HIV/Tb co-infected and HIV mono-infected patients was 26.3% and 17.94%, respectively.
Conclusion
The current systematic review and meta-analysis showed a high prevalence of hepatotoxicity among HIV-infected patients. Therefore, regular monitoring of hepatotoxicity among HIV-infected patients is required in order to avoid liver damage and other complications.
Systematic review registration PROSPERO (2022:CRD42022334704)
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Mugusi SF, Sando D, Mugusi FM, Hawkins C, Aboud S, Fawzi WW, Sudfeld CR. Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy. J Int Assoc Provid AIDS Care 2019; 18:2325958219884939. [PMID: 31665968 PMCID: PMC6900607 DOI: 10.1177/2325958219884939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). APPROACH We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. RESULTS We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL (P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L (P values: <.05). CONCLUSION Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.
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Affiliation(s)
- Sabina F. Mugusi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili
University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Global Health and Population, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
| | - Ferdinand M. Mugusi
- Department of Internal Medicine, School of Medicine, Muhimbili University of
Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Center for Global Health, Division of Infectious Diseases, Northwestern
University Feinberg School of Medicine, Chicago, IL, USA
| | - Said Aboud
- Department of Microbiology and Immunology, School of Medicine, Muhimbili
University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
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Varshney E, Tandon M, Saha N, Ali S. In vivo phenotyping of cytochrome 450 isoforms involved in the metabolism of anti-HIV and anti-tubercular drugs in human using cocktail approach: An LC-MS/MS analysis. J Pharm Biomed Anal 2018; 164:698-705. [PMID: 30472588 DOI: 10.1016/j.jpba.2018.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/25/2018] [Accepted: 11/11/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE In vivo phenotyping of CYP isoforms involved in the metabolism of anti-HIV and antitubercular drugs is important to determine therapeutic dose levels in HIV/AIDS-TB coinfections. In this study, we used a cocktail of bupropion, losartan and dapsone for in vivo phenotyping of CYP2B6, CYP2C9 and N-acetyltransferase-2 (NAT2) in plasma. CYP2B6 is the main catalyst of anti-HIV efavirenz, while NAT2 is involved in antitubercular drug isoniazid metabolism. CYP2C9 has a significant association with antitubercular drug-induced reactions. The activity level of these isoforms has a significant bearing on therapeutic dose in rapid and poor metabolizers. METHODS Briefly, a cocktail of probe drugs was administered to human volunteers and the drugs and metabolites were determined by an inhouse LC-MS/MS method in 250 μl plasma. The mobile phase and drug/metabolite extraction methods were optimized before analysis. Retention time, Cmax and tmax were calculated from the same sample and the values were used for phenotyping the isoforms. RESULTS Retention time of drugs and metabolites was calculated. The method was sensitive (4.5-8.2 %CV) and no interfering peak was observed in any batch. %Accuracy of the calibrator and QC was 85-115%. %CV of storage stability testing was within FDA approved limits. Cmax and tmax were comparable to the values reported for individual drugs. CONCLUSIONS This study advocates the use of a cocktail of bupropion, losartan and dapsone for in vivo phenotyping of CYP2B6, CYP2C9 and NAT2, which is important in determining therapeutic dose levels of anti-HIV and anti-TB drugs in HIV/AIDS-TB coinfections.
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Affiliation(s)
- Ekta Varshney
- Department of Biochemistry, School of Chemical and Life Science, Jamia Hamdard (Deemed University), Hamdard Nagar, New Delhi, 110062, India
| | - Monika Tandon
- Clinical Pharmacology Unit of Ranbaxy Laboratories Limited at Jamia Hamdard, India
| | - Nilanjan Saha
- Clinical Pharmacology Unit of Ranbaxy Laboratories Limited at Jamia Hamdard, India
| | - Shakir Ali
- Department of Biochemistry, School of Chemical and Life Science, Jamia Hamdard (Deemed University), Hamdard Nagar, New Delhi, 110062, India.
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Petros Z, Lee MTM, Takahashi A, Zhang Y, Yimer G, Habtewold A, Schuppe-Koistinen I, Mushiroda T, Makonnen E, Kubo M, Aklillu E. Genome-Wide Association and Replication Study of Hepatotoxicity Induced by Antiretrovirals Alone or with Concomitant Anti-Tuberculosis Drugs. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2017; 21:207-216. [PMID: 28388302 DOI: 10.1089/omi.2017.0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug-induced hepatotoxicity (DIH) is a common adverse event that is associated with both antiretroviral (ARV) and anti-tuberculosis drugs (ATD). Moreover, the genetic variations predisposing ARV- and ARV-ATD-induced liver toxicity in African populations are not well investigated, despite the two diseases being the major global health problems in sub-Saharan Africa. We performed a genome-wide association study (GWAS) and replication study to identify the genetic variants linked to the risk of developing DIH due to ARV drugs alone, and ARV-ATD co-treatment in Ethiopian HIV-positive patients. Treatment-naïve newly diagnosed HIV patients (n = 719) with or without tuberculosis (TB) co-infection were enrolled prospectively and received efavirenz-based ARV therapy with or without rifampicin-based short course ATD, respectively. Whole-genome genotyping was performed by using the Illumina Omni Express Exome Bead Chip genotyping array with 951,117 single nucleotide polymorphisms (SNPs) on a total of 41 cases of DIH, and 452 people without DIH (treatment tolerants). The replication study was carried out for 100 SNPs with the lowest p-values (top SNPs) by using an independent cohort consisting of 18 DIH cases and 208 treatment tolerants. We identified a missense SNP rs199650082 (2756G→A, R919Q, p = 1.4 × 10-6, odds ratio [OR] = 18.2, 95% confidence interval [CI] = 7.1-46.9) in an endoplasmic reticulum to the nucleus signaling-1 (ERN1) gene on chromosome 17 to be associated with DIH in the ARV-only cohort. In the ARV-ATD co-treatment groups, rs4842407, a long intergenic noncoding RNAs (lincRNAs) transcript variant on chromosome 12, was associated with DIH (p = 5.3 × 10-7, OR = 5.4, 95% CI = 2.8-10.3). These genetic variants that are putatively associated with DIH due to ARV drugs alone and ARV-ATD co-treatment establish a foundation for future personalized medicine in people with HIV and TB and call for larger studies in independent populations.
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Affiliation(s)
- Zelalem Petros
- 1 Laboratory for International Alliance on Genomic Research, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan .,2 Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Ming Ta Michael Lee
- 1 Laboratory for International Alliance on Genomic Research, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan
| | - Atsushi Takahashi
- 3 Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan
| | - Yanfei Zhang
- 1 Laboratory for International Alliance on Genomic Research, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan
| | - Getnet Yimer
- 2 Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Abiy Habtewold
- 2 Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Ina Schuppe-Koistinen
- 4 Department of Physiology and Pharmacology, Science for Life Laboratory, Karolinska Institutet , Stockholm, Sweden
| | - Taisei Mushiroda
- 5 Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan
| | - Eyasu Makonnen
- 2 Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Michiaki Kubo
- 6 Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences , Yokohama, Japan
| | - Eleni Aklillu
- 7 Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge C1:68 , KarolinskaInstitutet, Stockholm, Sweden
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Yimer G, Gry M, Amogne W, Makonnen E, Habtewold A, Petros Z, Aderaye G, Schuppe-Koistinen I, Lindquist L, Aklillu E. Evaluation of patterns of liver toxicity in patients on antiretroviral and anti-tuberculosis drugs: a prospective four arm observational study in ethiopian patients. PLoS One 2014; 9:e94271. [PMID: 24714066 PMCID: PMC3979833 DOI: 10.1371/journal.pone.0094271] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the incidence, type, severity and predictors of antiretroviral and/or anti-tuberculosis drugs induced liver injury (DILI). Methods A total of 1,060 treatment naive patients were prospectively enrolled into four treatment groups: HIV patients receiving efavirenz based HAART alone (Arm-1); TB-HIV co-infected patients with CD4≤200 cells/μL, receiving concomitant rifampicin based anti-TB and efavirenz based HAART (Arm-2); TB-HIV co-infected patients with CD4>200 cells/μL, receiving anti-TB alone (Arm-3); TB patients taking rifampicin based anti-TB alone (Arm-4). Liver enzyme levels were monitored at baseline, 1st, 2nd, 4th, 8th, 12th and 24th weeks during treatment. CD4 and HIV viral load was measured at baseline, 24th and 48th weeks. Data were analyzed using multivariate Cox Proportional Hazards Model. Results A total of 159 patients (15%) developed DILI with severity grades 1, 2, 3 and 4 of 53.5%, 32.7%, 11.3% and 2.5% respectively. The incidence of cholestatic, hepatocellular or mixed pattern was 61%, 15% and 24%, respectively. Incidence of DILI was highest in Arm-2 (24.2%)>Arm-3 (10.8%)>Arm-1 (8.8%)>Arm-4 (2.9%). Concomitant anti-TB-HIV therapy increased the risk of DILI by 10-fold than anti-TB alone (p<0.0001). HIV co-infection increased the risk of anti-TB DILI by 4-fold (p = 0.004). HAART associated DILI was 3-fold higher than anti-TB alone, (p = 0.02). HAART was associated with cholestatic and grade 1 DILI whereas anti-TB therapy was associated with hepatocellular and grade ≥ 2. Treatment type, lower CD4, platelet, hemoglobin, higher serum AST and direct bilirubin levels at baseline were significant DILI predictors. There was no effect of DILI on immunologic recovery or virologic suppression rate of HAART. Conclusion HAART associated DILI is mainly cholestatic and mild whereas hepatocellular or mixed pattern with high severity grade is more common in anti-tuberculosis DILI. TB-HIV co-infection, disease severity and concomitant treatment exacerbates the risk of DILI.
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Affiliation(s)
- Getnet Yimer
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge C1:68, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marcus Gry
- Former AstraZeneca R&D, Global Safety Assessment, Molecular Toxicology, Södertälje, Sweden
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge I:73, Stockholm, Sweden
| | - Eyasu Makonnen
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiy Habtewold
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge C1:68, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Petros
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Aderaye
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ina Schuppe-Koistinen
- AstraZeneca Innovative Medicines Personalised Healthcare & Biomarkers, Science for Life Laboratory, Solna, Sweden
| | - Lars Lindquist
- Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge I:73, Stockholm, Sweden
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge C1:68, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Hassen Ali A, Belachew T, Yami A, Ayen WY. Anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia: nested case-control study. PLoS One 2013; 8:e64622. [PMID: 23696901 PMCID: PMC3655990 DOI: 10.1371/journal.pone.0064622] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/17/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study was carried out to determine the incidence and predictors of anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia. METHODS/PRINCIPAL FINDINGS A nested case-control study was conducted by reviewing charts of all TB/HIV co-infected patients who commenced anti-TB treatment from January 2008 to December 2011 at Jimma University Hospital. Patients who had developed hepatotoxicity after at least 5 days of standard doses of anti-TB drug therapy were labeled as "cases" and those without hepatotoxicity were "controls". Each case with anti-TB drug induced hepatotoxicity was compared with 3 controls selected randomly from the cohort. From a cohort of 296 TB/HIV co-infected patients 8 were excluded from the study as the causality between anti-TB drugs and hepatotoxicity was not confirmed, 33 had developed hepatotoxicity. On bivariate logistic regression analysis, body mass index (BMI) <18.5 Kg/m(2) [P = 0.01; OR (95%CI): 3.6 (1.4-9.5)], disseminated pulmonary TB [P = 0.00; OR (95%CI): 5.6 (2.2-14.6)], CD4 count ≤50 [P = 0.016; OR (95%CI): 3.6(1.27-10.23)] and WHO stage 4 [P = 0.004, OR (95%CI): 3.8 (1.68-8.77)] were significantly associated with anti-TB drug induced hepatotoxicity. Predictor variables with p-value <0.05 by bivariate analysis were analyzed using multivariable logistic regression analysis and identified disseminated pulmonary TB [P = 0.001; AOR (95%CI) = 5.6 (2.1-15.0)] and BMI <18.5 [P = 0.014; AOR (95%CI)= 3.6 (1.3-10.1)] as independent predictors of anti-TB drug induced hepatotoxicity. CONCLUSIONS The incidence of anti-TB drug induced hepatotoxicity was 11.5%. The results suggest that in the presence of disseminated pulmonary TB and/or BMI <18.5 Kg/m(2), TB/HIV co-infected patients should be closely followed for the occurrence of hepatotoxicity during the intensive phase of TB treatment to prevent morbidity and mortality.
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Affiliation(s)
| | - Tefera Belachew
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Alemeshet Yami
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
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Partovi S, Aschwanden M, Jacobi B, Schulte AC, Walker UA, Staub D, Imfeld S, Broz P, Benz D, Zipp L, Jaeger KA, Takes M, Robbin MR, Huegli RW, Bilecen D. Correlation of muscle BOLD MRI with transcutaneous oxygen pressure for assessing microcirculation in patients with systemic sclerosis. J Magn Reson Imaging 2013; 38:845-51. [PMID: 23441019 DOI: 10.1002/jmri.24046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/17/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To prospectively compare calf muscle BOLD MRI with transcutaneous oxygen pressure (TcPO2 ) measurement in patients with systemic sclerosis (SSc) and healthy volunteers and thereby get insight into the pathogenesis of vasculopathy in this connective tissue disorder. MATERIALS AND METHODS Twelve patients with SSc (6 women and 6 men, mean age 53.5 ± 10.0 years) and 12 healthy volunteers (4 men and 8 women, mean age 47 ± 12.1 years) were examined using muscle BOLD MRI and TcPO2. A cuff compression at mid-thigh level was performed to provoke ischemia and reactive hyperemia. BOLD measurements were acquired on a 3 Tesla whole body-scanner in the upper calf region using a multi-echo EPI-sequence with four echo-times (TE: 9/20/31/42 ms) and a repetition time of 2 s. Empirical cross-correlation analysis depending on time lags between BOLD- and TcPO2-measurements was performed. RESULTS Maximal cross-correlation of BOLD T2*- and TcPO2-measurements was calculated as 0.93 (healthy volunteers) and 0.90 (SSc patients) for a time lag of approximately 40 s. Both modalities showed substantial differences regarding time course parameters between the SSc patients and healthy volunteers. CONCLUSION Skeletal muscle BOLD MRI correlated very well with TcPO2 . T2* changes seem to reflect reoxygenation deficits in deeper muscle tissue of SSc patients.
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Affiliation(s)
- Sasan Partovi
- University Hospital Bruderholz, Department of Radiology and Nuclear Medicine, Basel, Switzerland; University Hospitals Case Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, Ohio
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Brown C, Oki NO, Hariani G, Motsinger-Reif AA. Research Highlights. Pharmacogenomics 2012; 13:137-8. [DOI: 10.2217/pgs.11.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Chad Brown
- Bioinformatics Research Center, Department of Statistics, North Carolina State University, Raleigh, NC 27695, USA
| | - Noffisat O Oki
- Bioinformatics Research Center, Department of Statistics, North Carolina State University, Raleigh, NC 27695, USA
| | - Gunjan Hariani
- Bioinformatics Research Center, Department of Statistics, North Carolina State University, Raleigh, NC 27695, USA
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Yimer G, Ueda N, Habtewold A, Amogne W, Suda A, Riedel KD, Burhenne J, Aderaye G, Lindquist L, Makonnen E, Aklillu E. Pharmacogenetic & pharmacokinetic biomarker for efavirenz based ARV and rifampicin based anti-TB drug induced liver injury in TB-HIV infected patients. PLoS One 2011; 6:e27810. [PMID: 22162992 PMCID: PMC3232196 DOI: 10.1371/journal.pone.0027810] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/25/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Implication of pharmacogenetic variations and efavirenz pharmacokinetics in concomitant efavirenz based antiviral therapy and anti-tubercular drug induced liver injury (DILI) has not been yet studied. We performed a prospective case-control association study to identify the incidence, pharmacogenetic, pharmacokinetic and biochemical predictors for anti-tubercular and antiretroviral drugs induced liver injury (DILI) in HIV and tuberculosis (TB) co-infected patients. METHODS AND FINDINGS Newly diagnosed treatment naïve TB-HIV co-infected patients (n = 353) were enrolled to receive efavirenz based ART and rifampicin based anti-TB therapy, and assessed clinically and biochemically for DILI up to 56 weeks. Quantification of plasma efavirenz and 8-hydroxyefaviernz levels and genotyping for NAT2, CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 genes were done. The incidence of DILI and identification of predictors was evaluated using survival analysis and the Cox Proportional Hazards Model. The incidence of DILI was 30.0%, or 14.5 per 1000 person-week, and that of severe was 18.4%, or 7.49 per 1000 person-week. A statistically significant association of DILI with being of the female sex (p = 0.001), higher plasma efavirenz level (p = 0.009), efavirenz/8-hydroxyefavirenz ratio (p = 0.036), baseline AST (p = 0.022), ALT (p = 0.014), lower hemoglobin (p = 0.008), and serum albumin (p = 0.007), NAT2 slow-acetylator genotype (p = 0.039) and ABCB1 3435TT genotype (p = 0.001). CONCLUSION We report high incidence of anti-tubercular and antiretroviral DILI in Ethiopian patients. Between patient variability in systemic efavirenz exposure and pharmacogenetic variations in NAT2, CYP2B6 and ABCB1 genes determines susceptibility to DILI in TB-HIV co-infected patients. Close monitoring of plasma efavirenz level and liver enzymes during early therapy and/or genotyping practice in HIV clinics is recommended for early identification of patients at risk of DILI.
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Affiliation(s)
- Getnet Yimer
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nobuhisa Ueda
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Abiy Habtewold
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Akira Suda
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Klaus-Dieter Riedel
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Getachew Aderaye
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lars Lindquist
- Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Eyasu Makonnen
- Department of Pharmacology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Yimer G, Amogne W, Habtewold A, Makonnen E, Ueda N, Suda A, Worku A, Haefeli WE, Burhenne J, Aderaye G, Lindquist L, Aklillu E. High plasma efavirenz level and CYP2B6*6 are associated with efavirenz-based HAART-induced liver injury in the treatment of naïve HIV patients from Ethiopia: a prospective cohort study. THE PHARMACOGENOMICS JOURNAL 2011; 12:499-506. [DOI: 10.1038/tpj.2011.34] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ortu F, Weimer LE, Floridia M, Manconi PE. Raltegravir, tenofovir, and emtricitabine in an HIV-infected patient with HCV chronic hepatitis, NNRTI intolerance and protease inhibitors-induced severe liver toxicity. Eur J Med Res 2010; 15:81-3. [PMID: 20452889 PMCID: PMC3352050 DOI: 10.1186/2047-783x-15-2-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background in HIV-infected patients with HCV-related chronic hepatitis, liver impairment and drug toxicity may substantially reduce the number of possible therapeutic options. Case Description we here describe the case of an HCV-HIV coinfected woman who had repeated severe episodes of drug-related liver toxicity with indinavir, saquinavir, fosamprenavir, and darunavir, with minimal further therapeutic options left in this class. Previous treatment-limiting side effects with efavirenz and nevirapine also precluded use of non-nucleoside reverse transcriptase inhibitors. Introduction of an integrase-inhibitor regimen based on raltegravir, tenofovir, and emtricitabine allowed a prompt achievement of undetectable viral load and a substantial rise of CD4 count to high levels, with no subsequent episodes of hepatic toxicity, and no other side effects. Conclusions given the relatively common prevalence of HCV-related chronic hepatitis among people with HIV, raltegravir might represent an important alternative option for a substantial number of patients who cannot be treated with protease inhibitors or NNRTI because of drug-related hepatic toxicity.
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Affiliation(s)
- F Ortu
- Clinic of Infectious Diseaes, Department of Medicine and Immunology, University of Cagliari, Italy
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Mata-Marín JA, Gaytán-Martínez J, Grados-Chavarría BH, Fuentes-Allen JL, Arroyo-Anduiza CI, Alfaro-Mejía A. Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study. Virol J 2009; 6:181. [PMID: 19878552 PMCID: PMC2777159 DOI: 10.1186/1743-422x-6-181] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 10/30/2009] [Indexed: 12/27/2022] Open
Abstract
Abnormalities in liver function tests could be produced exclusively by direct inflammation in hepatocytes, caused by the human immunodeficiency virus (HIV). Mechanisms by which HIV causes hepatic damage are still unknown. Our aim was to determine the correlation between HIV viral load, and serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as markers of hepatic damage in HIV naive infected patients. We performed a concordance cross-sectional study. Patients with antiviral treatment experience, hepatotoxic drugs use or co-infection were excluded. We used a Pearson's correlation coefficient to calculate the correlation between aminotransferases serum levels with HIV viral load. We enrolled 59 patients, 50 men and 9 women seen from 2006 to 2008. The mean (+/- SD) age of our subjects was 34.24 +/- 9.5, AST 37.73 +/- 29.94 IU/mL, ALT 43.34 +/- 42.41 IU/mL, HIV viral load 199,243 +/- 292,905 copies/mL, and CD4+ cells count 361 +/- 289 cells/mm(3). There was a moderately strong, positive correlation between AST serum levels and HIV viral load (r = 0.439, P < 0.001); and a weak correlation between ALT serum levels and HIV viral load (r = 0.276, P = 0.034); after adjusting the confounders in lineal regression model the correlation remained significant. Our results suggest that there is an association between HIV viral load and aminotransferases as markers of hepatic damage; we should improved recognition, diagnosis and potential therapy of hepatic damage in HIV infected patients.
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Affiliation(s)
- José Antonio Mata-Marín
- Infectious Diseases Department, Hospital de Infectología, "La Raza" National Medical Center, IMSS, Mexico City, México.
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