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OUP accepted manuscript. J Pharm Pharmacol 2022; 74:905-917. [DOI: 10.1093/jpp/rgac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022]
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Neukam K, Espinosa N, Collado A, Delgado-Fernández M, Jiménez-Aguilar P, Rivero-Juárez A, Hontañón-Antoñana V, Gómez-Berrocal A, Ruiz-Morales J, Merino D, Carrero A, Téllez F, Ríos MJ, Hernández-Quero J, de Lagarde-Sebastián M, Pérez-Camacho I, Vera-Méndez F, Macías J, Pineda JA. Hepatic Safety of Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate Fixed-Dose Single-Tablet Regimen in HIV-Infected Patients with Active Hepatitis C Virus Infection: The hEPAtic Study. PLoS One 2016; 11:e0155842. [PMID: 27195797 PMCID: PMC4873169 DOI: 10.1371/journal.pone.0155842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)-coinfected subjects in clinical practice. METHODS In a retrospective analysis, HIV/HCV-coinfected subjects who started EPA at 17 centres throughout Spain were included as cases. Subjects who started an antiretroviral therapy (ART) other than EPA during the study period at the same hospitals were randomly selected as controls in a 1:2 ratio. Primary outcome variables were grade (G) 3-4 TE and G4 TBE. RESULTS Of the 519 subjects included, 173 individuals started EPA. Nine (5.2%) subjects of the EPA group and 49 (14.2%) controls were naïve to ART. The median (Q1-Q3) follow-up was 11.2 (9.7-13.9) months. TE was observed in 2 [1.2%; 95% confidence interval (CI): 0.14%-4.1%] subjects receiving EPA and 11 (3.2%; 95%CI: 1.6%-5.6%) controls (p = 0.136), all events were G3. No patient discontinued ART due to TE. One (0.6%; 95%CI: 0.01%-3.1%) subject on EPA and 8 (2.3%; 95%CI: 1%-4.5%) subjects in the control group developed TBE (p = 0.141), without developing any other hepatic event during follow-up. Three (2.3%) subjects with cirrhosis versus 10 (3.1%) without cirrhosis showed G3-4 TE (p = 0.451). CONCLUSION The frequency of severe liver toxicity in HIV/HCV-coinfected subjects receiving EPA under real-life conditions is very low, TE were generally mild and did not lead to drug discontinuation. All these data suggest that EPA can be safely used in this particular subpopulation.
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Affiliation(s)
- Karin Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- * E-mail:
| | - Nuria Espinosa
- Service of Infectious Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio Collado
- Unit of Infectious Diseases, Hospital Torrecárdenas, Almeria, Spain
| | | | | | - Antonio Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain
| | | | - Ana Gómez-Berrocal
- Service of Internal/Infectious Medicine, Hospital Universitario de la Princesa, Madrid, Spain
| | - Josefa Ruiz-Morales
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Huelva, Spain
| | - Ana Carrero
- Unit of Infectious Diseases/HIV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital La Línea, AGS Campo de Gibraltar, La Linea de la Concepcion, Spain
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Virgen Macarena, Seville, Spain
| | | | | | | | | | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Juan A. Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Brown HR, Castellino S, Groseclose MR, Elangbam CS, Mellon-Kusibab K, Yoon LW, Gates LD, Krull DL, Cariello NF, Arrington-Brown L, Tillman T, Fowler S, Shah V, Bailey D, Miller RT. Drug-induced Liver Fibrosis. Toxicol Pathol 2016; 44:112-31. [DOI: 10.1177/0192623315617033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nevirapine (NVP) is associated with hepatotoxicity in 1–5% of patients. In rodent studies, NVP has been shown to cause hepatic enzyme induction, centrilobular hypertrophy, and skin rash in various rat strains but not liver toxicity. In an effort to understand whether NVP is metabolized differently in a transiently inflamed liver and whether a heightened immune response alters NVP-induced hepatic responses, female brown Norway rats were dosed with either vehicle or NVP alone (75 mg/kg/day for 15 days) or galactosamine alone (single intraperitoneal [ip] injection on day 7 to mimic viral hepatitis) or a combination of NVP (75/100/150 mg/kg/day for 15 days) and galactosamine (single 750 mg/kg ip on day 7). Livers were collected at necropsy for histopathology, matrix-assisted laser desorption/ionization imaging mass spectrometry and gene expression. Eight days after galactosamine, hepatic fibrosis was noted in rats dosed with the combination of NVP and galactosamine. No fibrosis occurred with NVP alone or galactosamine alone. Gene expression data suggested a viral-like response initiated by galactosamine via RNA sensors leading to apoptosis, toll-like receptor, and dendritic cell responses. These were exacerbated by NVP-induced growth factor, retinol, apoptosis, and periostin effects. This finding supports clinical reports warning against exacerbation of fibrosis by NVP in patients with hepatitis C.
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Affiliation(s)
- H. Roger Brown
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Stephen Castellino
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - M. Reid Groseclose
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Chandikumar S. Elangbam
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Kathryn Mellon-Kusibab
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Lawrence W. Yoon
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Lisa D. Gates
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - David L. Krull
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Neal F. Cariello
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Leigh Arrington-Brown
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Tony Tillman
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Serita Fowler
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Vishal Shah
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - David Bailey
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Richard T. Miller
- Department of Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
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Chong JJ, Fragaszy E, Dukes O, Cason J, Kozlakidis Z. Serum Albumin Concentrations in a Multi-Ethnic Cohort of Patients with Human Immunodeficiency Virus Infection from South East London. Biores Open Access 2015; 4:160-3. [PMID: 26309792 PMCID: PMC4497629 DOI: 10.1089/biores.2014.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human albumin is the most abundant protein in sera and a valuable biomarker in monitoring a variety of diseases. In this study we investigated the relationship between serum albumin concentrations and effects of initiation of highly active antiretroviral therapy (HAART). Serum albumin concentrations amongst 70 HIV-infected patients from diverse ethnicities were analyzed, in the absence of any other confounding comorbidities, over a period of 8 years in South East London, United Kingdom. Serum albumin data was collected, on average, every 4–6 weeks during routine visits. Serum albumin was measured prior to starting HAART, and measured at the first clinic visit after commencing HAART. These were compared to a control group of untreated individuals. Based on our analyses we conclude that serum albumin concentrations increase significantly after the initiation of therapy.
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Affiliation(s)
- James Jy Chong
- King's College London, School of Medicine , Guy's Campus, Guy's Hospital, Great Maze Pond, London, United Kingdom
| | - Ellen Fragaszy
- University College London , Institute of Health Informatics and the Farr Institute of Health Informatics Research, London, United Kingdom
| | - Oliver Dukes
- University College London , Institute of Health Informatics and the Farr Institute of Health Informatics Research, London, United Kingdom
| | - John Cason
- King's College London, School of Medicine , Guy's Campus, Guy's Hospital, Great Maze Pond, London, United Kingdom
| | - Zisis Kozlakidis
- University College London , Infection and Immunity and the Farr Institute of Health Informatics Research, London, United Kingdom
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Viciana-Fernández P, Falcó V, Castaño M, de los Santos-Gil I, Olalla-Sierra J, Hernando A, Deig E, Clotet B, Knobel H, Podzamczer D, Pedrol PD. [Barriers to ART initiation in HIV infected subjects and with treatment indication in Spain. Why don't they start their treatment? Bridgap Study]. Enferm Infecc Microbiol Clin 2015; 33:397-403. [PMID: 25577557 DOI: 10.1016/j.eimc.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/06/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In Spain, HIV treatment guidelines are well known and generally followed. However, in some patients there are no plans to initiate ART despite having treatment indications. The current barriers to ART initiation are presented. METHODS A cross-sectional survey including every HIV infected patient in care in 19 hospitals across Spain in 2012, with ≥1 indication to start ART according to 2011 national treatment guidelines, who had not been scheduled for ART initiation. Reasons for deferring treatment were categorized as follows (non-exclusive categories): a) The physician thinks the indication is not absolute and prefers to defer it; b) The patient does not want to start it; c) The physician thinks ART must be started, but there is some limitation to starting it, and d) The patient has undetectable viral load in absence of ART. RESULTS A total of 256 patients, out of 784 originally planned, were included. The large majority (84%) were male, median age 39 years, 57% MSM, 24% heterosexuals, and 16% IDUs. Median time since HIV diagnosis was 3 years, median CD4 count, 501 cells/mm3, median viral load 4.4 log copies/ml. Main ART indications were: CD4 count <500 cells/mm(3), 48%; having an uninfected sexual partner, 28%, and hepatitis C coinfection, 23%. Barriers due to, the physician, 55%; the patient, 28%; other limitations, 23%; and undetectable viral load, 6%. CONCLUSIONS The majority of subjects with ART indication were on it. The most frequent barriers among those who did not receive it were physician-related, suggesting that the relevance of the conditions that indicate ART may need reinforcing.
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Affiliation(s)
| | - Vicenç Falcó
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - Manuel Castaño
- Servicio de Enfermedades Infecciosas, Hospital Regional Carlos Haya, Málaga, España
| | | | | | - Asunción Hernando
- Unidad de VIH, Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España
| | - Elisabet Deig
- Unidad de VIH-Servicio de Medicina Interna, Hospital General de Granollers, Granollers, España
| | | | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, España
| | - Daniel Podzamczer
- Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
| | - Pere Domingo Pedrol
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Barreiro P, Pineda JA, Rallón N, Naggie S, Martín-Carbonero L, Neukam K, Rivero A, Benito JM, Caruz A, Vispo E, Camacho A, Medrano J, McHutchison J, Soriano V. Influence of interleukin-28B single-nucleotide polymorphisms on progression to liver cirrhosis in human immunodeficiency virus-hepatitis C virus-coinfected patients receiving antiretroviral therapy. J Infect Dis 2011; 203:1629-36. [PMID: 21592993 DOI: 10.1093/infdis/jir113] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) near the IL28B gene have recently been associated with spontaneous hepatitis C virus (HCV) clearance and response to interferon-based therapies in patients with chronic hepatitis C. Because human immunodeficiency virus (HIV) coinfection appears to accelerate HCV-related liver fibrosis progression, any influence of IL28B SNP on the risk of developing cirrhosis might be more easily recognized in the coinfected population. METHODS All HIV-HCV-coinfected patients who underwent hepatic elastography before initiating a course of pegylated interferon plus ribavirin therapy at 2 Spanish clinics were retrospectively identified. Liver cirrhosis was defined as >14.5 kPa by transient elastography. The IL28B rs12979860 SNP was examined in a blinded fashion. RESULTS A total of 304 HIV-HCV-coinfected individuals were analyzed (mean age, 43 years; 80% were male; and 85% were receiving antiretroviral therapy), of whom 18% had cirrhosis. IL28B genotype distribution was as follows: CC, 46%; CT, 43%; and TT, 11%. Cirrhosis was more frequent in CC than CT/TT carriers (24% vs 13%; P = .01). Logistic regression analysis revealed that older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.99-1.12]; P = .08), past alcohol abuse (OR, 1.97; 95% CI, 0.95-4.06; P = .07), and CC IL28B genotype (OR, 2.32; 95% CI, 1.22-4.41; P = .01) were predictors of cirrhosis. Interestingly, mean (SD) alanine aminotransferase (ALT) levels were greater (90 ± 53 vs 71 ± 33 IU/L;, P = .01) in IL28B CC than CT/TT carriers during the prior 4.8 ± 3.8 years. CONCLUSIONS The IL28B rs12979860 CC genotype is associated with a higher prevalence of cirrhosis in HIV-HCV-coinfected patients than CT/TT genotypes, suggesting that IL28B CC carriers may experience a more rapid progression of HCV-related liver fibrosis, perhaps as result of increased liver inflammation. Thus, access to HCV treatment is of utmost importance in IL28B CC carriers, in whom treatment response is better and in whom progression to cirrhosis might occur more rapidly.
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Affiliation(s)
- Pablo Barreiro
- Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.
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Kennedy A, Hennessy M, Bergin C, Mulcahy F, Hopkins S, Spiers JP. Ribavirin and interferon alter MMP-9 abundance in vitro and in HIV–HCV-coinfected patients. Antivir Ther 2011; 16:1237-47. [DOI: 10.3851/imp1867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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