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Mengistu EF, Malik DT, Molla MD, Adugna A, Jemal M. Liver function tests, CD4 + counts, and viral load among people living with HIV on dolutegravir compared to efavirenz-based cART; a comparative cross-sectional study. Heliyon 2024; 10:e33054. [PMID: 38988551 PMCID: PMC11234096 DOI: 10.1016/j.heliyon.2024.e33054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Background Recently, dolutegravir-based therapy has become the first-line treatment when compared to others. However, dolutegravir-associated side effects in the liver and levels of efficacy haven't been addressed yet in underdeveloped countries such as Ethiopia. Objective The purpose of this study was to compare liver function tests, CD4+ counts, and viral load among people living with HIV on dolutegravir and efavirenz-based antiretroviral regimens at Debre Markos Comprehensive Specialized Hospital in Northwest Ethiopia. Methods An institutional-based comparative cross-sectional study was carried out from May 20 to July 10, 2020. An equal number of dolutegravir and efavirenz-prescribed patients (n = 53 each) for 6 months and above were included, and a judgmental sampling technique was used. A comparison of categorical and continuous parameters was analyzed with chi-square and an independent t-test, respectively, using SPSS version 26. A multivariable logistic regression was conducted and considered statistically significant at a p-value of <0.05. Results The magnitude of liver enzyme (AST/ALT) abnormalities was 22.4 % (12/53) and 30.2 % (16/53) among dolutegravir- and efavirenz-prescribed patients, respectively. The dolutegravir group had significantly higher mean CD4+ counts than the efavirenz group (589.40 ± 244.38 vs. 450.64 ± 203.54 cell/mm3; p = 0.002). The efavirenz group had a significantly higher mean viral load than the dolutegravir group (783.83 ± 476.82 vs. 997.98 ± 439.11 cp/ml; p = 0.032). There was a statistically insignificant difference in AST (p = 0.709) or ALT (p = 0.687) between dolutegravir and efavirenz-based regimens. The multivariable logistic regression analysis revealed that BMI ≥25 kg/m2 was associated with liver enzyme abnormalities (AOR = 6.60, 95 % CI: 1.17, 42.82). Conclusion A dolutegravir-based regimen was more likely to result in patients achieving higher efficacy for viral suppression and a CD4+ count increase. Although the differences were statistically insignificant, the mean AST and ALT levels were marginally higher in efavirenz-treated groups than in dolutegravir-treated groups.
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Affiliation(s)
- Enyew Fenta Mengistu
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Dr Tabarak Malik
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adane Adugna
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mohammed Jemal
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Roen AO, Peters L, Wandeler G, van der Valk M, Zangerle R, Günthard HF, Wit F, Mussini C, De Wit S, d’Arminio Monforte A, Vehreschild JJ, Castagna A, Jaschinski N, Vannappagari V, Chen L, Tallada J, C’mar J, Mocroft A, Ryom L. Chronic Liver Enzyme Elevation and Use of Contemporary ARVs Among People With HIV. Open Forum Infect Dis 2024; 11:ofae308. [PMID: 38919512 PMCID: PMC11196901 DOI: 10.1093/ofid/ofae308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Background While use of some older antiretroviral drugs (ARVs) is associated with chronic liver enzyme elevation (cLEE), the impact of newer ARVs remains unknown. Methods People with HIV enrolled in the RESPOND cohort who started an ARV after January 1, 2012 were included (baseline). The primary outcome was first cLEE individuals were censored at first of cLEE, last visit, death, or December 31, 2021. Incidence rates (IRs; events/1000 person-years) were calculated for each ARV overall and by ARV exposure (6-12 months, 1-2 years, and 2+ years). Poisson regression was used to estimate the incidence rate ratio (IRR) of cLEE and its association with individual ARVs and ARV class. Results Of 17 106 individuals included contributing 87 924 person-years of follow-up, 1932 (11.3%) experienced cLEE (incidence rate [IR], 22.0; 95% CI, 21.0-23.0). There was no evidence of a cumulative ARV effect on cLEE incidence, (6-12 months: IR, 45.8; 95% CI, 41.4-50.19; 1-2 years: IR, 34.3; 95% CI, 31.5-37.4; and 2+ years: IR, 18.5; 95% CI, 17.4-19.7). Any use (vs no prior use) of non-nucleoside reverse transcriptase inhibitors (NNRTIs) as a class and tenofovir disoproxil fumarate (TDF) was independently associated with an increased IRR of cLEE, and any use of darunavir (DRV) was associated with a decreased risk of cLEE. Conclusions cLEE is common and more frequent during the first year after initiating new ARVs. With a >5-year median follow-up, we found no short-term liver safety concerns with the use of INSTIs. Use of NNRTIs and TDF was associated with an increased cLEE risk, while DRV was associated with lower risk.
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Affiliation(s)
- Ashley O Roen
- Institute for Global Health, University College London, London, UK
| | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc van der Valk
- Stichting HIV Monitoring Amsterdam, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, University of Amsterdam, Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Stéphane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | | | | | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | | | | | - Linda Chen
- Gilead Science, Foster City, California, USA
| | - Joan Tallada
- European AIDS Treatment Group, Brussels, Belgium
| | | | - Amanda Mocroft
- Institute for Global Health, University College London, London, UK
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ryom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Taramasso L, Lorenzini P, Di Biagio A, Lichtner M, Marchetti G, Rossotti R, Lapadula G, Cozzi-Lepri A, Vichi F, Antinori A, Bonora S, d'Arminio Monforte A. Incidence and risk factors for liver enzyme elevation among naive HIV-1-infected patients receiving ART in the ICONA cohort. J Antimicrob Chemother 2020; 74:3295-3304. [PMID: 31504633 DOI: 10.1093/jac/dkz353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/17/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To evaluate the incidence and risk factors for liver enzyme elevations (LEE) in patients initiating first-line ART in the ICONA prospective observational cohort, between June 2009 and December 2017. PATIENTS AND METHODS In total, 6575 ART-naive patients were selected, initiating two NRTIs with the third drug being a boosted PI (n=2436; 37.0%), an NNRTI (n=2384; 36.3%) or an integrase strand transfer inhibitor (INSTI) (n=1755; 26.7%). HBV surface antigen and HCV RNA were detected in 3.9% and 5.8% of the study population. Inverse probability weighted Cox regression analysis was used to calculate the HRs, according to first-line regimen, for LEE, defined as ALT or AST increases of ≥2.5× upper limit of normal (ULN) for patients with normal baseline values or ≥2.5× baseline for patients with higher baseline values. RESULTS One hundred and eighty-three LEE occurred over 20722 patient-years of follow-up. After adjusting for the main confounders, the risk of LEE halved with INSTIs compared with NNRTIs (HR 0.46, 95% CI 0.25-0.86), with a significant reduction in the raltegravir group (HR 0.11, 95% CI 0.02-0.84 using the NNRTI class as reference). HRs for LEE were significantly higher in subjects with HBV or HCV coinfection, in patients with poorly controlled HIV infection and in those who acquired HIV through homosexual transmission. CONCLUSIONS In our study, INSTI use almost halved the risk of LEE compared with other regimens. This finding could be particularly important for choosing ART in patients with risk factors for liver toxicity such as HCV and HBV coinfections.
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Affiliation(s)
- Lucia Taramasso
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Lorenzini
- HIV/AIDS Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Genoa, Italy
| | - Miriam Lichtner
- Department of Infectious Diseases, La Sapienza University, Polo Pontino, Latina, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious and Tropical Diseases, University of Milan, Milan, Italy
| | | | | | | | - Francesca Vichi
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Florence, Italy
| | - Andrea Antinori
- HIV/AIDS Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
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Tang YF, Jiang P, Zhang YB, Wang XW, Wang YB, Zhang QY, Teng Y, Yu H, Meng H, Zhang W, Ma Z. Risk factors for COVID-19-related liver injury. Shijie Huaren Xiaohua Zazhi 2020; 28:691-698. [DOI: 10.11569/wcjd.v28.i15.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abnormal liver function is frequently present in patients with coronavirus disease-2019 (COVID-19), and the reasons for abnormal liver function are still largely unknown. In the present study, we performed a retrospective analysis of COVID-19 cases to identify the risk factors for liver injury.
AIM To identify the risk factors for COVID-19-related liver injury.
METHODS One-hundred patients with confirmed COVID-19 who were hospitalized at Huoshenshan Hospital between February 4 and February 29, 2020 were included. Basic information and laboratory parameters (liver function tests) were collected and analyzed.
RESULTS Of the 100 COVID-19 patients included, 54% were male and 46% were female. The average age was 59.89 ± 13.07 years. The patients had clinical manifestations of fever (81%), cough (64%), and limb fatigue (52%) at preadmission. Abnormal liver function was observed in 38 patients, including elevated alanine aminotransferase (ALT; 28 patients), aspartate aminotransferase (AST; 10 patients), and gamma-glutamyl transferase (GGT; 20 patients). Patients who had elevated ALT, AST, or GGT were significantly more often present in male patients (P < 0.001, P = 0.006 and P < 0.001, respectively). There was no statistical difference in liver function parameters between patients who received and did not receive prehospital treatment.
CONCLUSION Abnormal liver function is more likely to be observed in male patients with COVID-19.
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Affiliation(s)
- Yu-Fu Tang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Peng Jiang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Yi-Bing Zhang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Xin-Wei Wang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Yuan-Bo Wang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Quan-Yu Zhang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Yue Teng
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Hao Yu
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Hao Meng
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
| | - Wei Zhang
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Zhuang Ma
- the General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China,Huoshenshan Hospital, Wuhan 430013, Hubei Province, China
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Soares J, Ferreira A, Silva-Pinto A, Almeida F, Piñeiro C, Serrão R, Sarmento A. The Influence of Antiretroviral Therapy on Hepatitis C Virus Viral Load and Liver Fibrosis in Human Immunodeficiency Virus-Coinfected Patients: An Observational Study. Intervirology 2019; 62:182-190. [PMID: 31775148 DOI: 10.1159/000503631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of antiretroviral therapy (ART) for Hepatitis C viral load (HCV-VL) and liver fibrosis is poorly understood. This study aimed at evaluating the influence of ART on HCV-VL and liver fibrosis in human immunodeficiency virus (HIV)/HCV-coinfected patients. METHODS We conducted a retrospective cohort study of HIV/HCV-coinfected patients followed at a tertiary university hospital. RESULTS In total, 143 patients were included. In 61 patients, ART initiation was accompanied by an increase in HCV-VL and a decrease in HIV viral load (HIV-VL), whereas ART suspension led to a decrease in HCV-VL and an increase in HIV-VL. Among the 55 HIV-suppressed patients who switched to a raltegravir (RAL)-containing regimen, median HCV-VL levels decreased significantly, while switching to a rilpivirine-containing regimen did not yield a significant reduction. DISCUSSION If the -treatment of chronic hepatitis starts before ART, ART initiation should be delayed as much as possible. If ART has been started, it is advisable to wait 1 year before initiating chronic hepatitis treatment. RAL as the third agent in an ART regimen could be beneficial in HIV/HCV-coinfected patients, in comparison to other antiretroviral drugs. CONCLUSION The start and the suspension of ART significantly interferes with HCV-VL in HIV/HCV-coinfected patients.
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Affiliation(s)
- Jorge Soares
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - António Ferreira
- Medicine Department, Hospital de Viana do Castelo, Viana do Castelo, Portugal
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal,
| | - Francisco Almeida
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - Carmela Piñeiro
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosário Serrão
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
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Abstract
: Elevation of liver transaminases is common in patients infected with the HIV. Although this is usually an incidental finding during regular work-up, HIV-infected patients with transaminase elevations require additional visits for laboratory studies and clinical assessments, and often undergo interruptions and changes in antiretroviral therapy (ART). Alanine aminotransferase is present primarily in the liver, thus being a surrogate marker of hepatocellular injury. Aspartate aminotransferase is present in the liver and other organs, namely cardiac and skeletal muscle, kidney and brain. Serum levels of both liver transaminases predict liver-related mortality. Moreover, serum fibrosis biomarkers based on alanine aminotransferase and aspartate aminotransferase predict all-cause mortality. In a busy clinical setting, a diagnostic approach to elevated liver transaminases could be complicated given the frequency and nonspecificity of this finding. Indeed, HIV-infected individuals present multiple risk factors for liver damage and chronic elevation of transaminases, including coinfection with hepatitis B and C viruses, alcohol abuse, hepatotoxicity due to ART, HIV itself and frequent metabolic comorbidities leading to nonalcoholic fatty liver disease. This review provides an update on epidemiology of elevated liver transaminases, summarizes the main etiologic contributors and discusses the prognostic significance and a pragmatic approach to this frequent finding in the clinical practice of HIV medicine. With the aging of the HIV-infected population following the successful implementation of ART in Western countries, liver-related conditions are now a major comorbidity in this setting. As such, clinicians should be aware of the frequency, clinical significance and diagnostic approach to elevated liver transaminases.
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Late Response of Antiretroviral Therapy in an HIV-1-Infected Patient due to Hepatitis B and C Coinfections: The First Case Report in Nepal. Case Rep Med 2019; 2019:2070973. [PMID: 30886633 PMCID: PMC6388324 DOI: 10.1155/2019/2070973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 01/19/2023] Open
Abstract
Aim Dual coinfection of HCV and HBV in HIV-1-infected population is a leading cause of morbidity and mortality. Also, they share routes of HIV transmission; however, it might be associated with an independent factor like injecting drug use for HCV and unsafe sex for HBV. This case report suggests that hepatitis virus coinfection may lead to late response of antiretroviral therapy (ART) in HIV-1 patients. Patients and Methods A 49-year-old male patient visited for the routine follow-up investigation at the National Public Health Laboratory (NPHL), Teku, Nepal. He was an HIV-1-positive injecting drug user (IDU) co-infected with HCV and HBV. The patient was under ART as per the National HIV Testing and Treatment Guidelines 2017, Nepal. Further, serological and viral load testing was performed for confirmation and monitoring therapy, respectively. Results It is the first report that highlights the dual coinfection of HCV and HBV in an HIV-1 patient from Nepal. The follow-up investigation shows improved response to ART with an increase in CD4+ cells. However, detectable viral loads indicated for a late response might be due to effects of coinfections or viral interactions. Conclusions Dual coinfection is rare; however, it is more serious with poorly defined epidemiology and evolution in an HIV-1-infected population. Thus, universal screening of HBV or/and HCV coinfection in HIV-1-infected population requires immediate implementation for true prevalence, proper management, and early intervention.
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Horberg MA, Oakes AH, Hurley LB, Towner WJ, Chao CR, Silverberg MJ, Chantra JQ, Ellis CG, Quesenberry CP. Association of raltegravir use with long-term health outcomes in HIV-infected patients: an observational post-licensure safety study in a large integrated healthcare system. HIV CLINICAL TRIALS 2018; 19:177-187. [PMID: 30370835 DOI: 10.1080/15284336.2018.1523826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Raltegravir became the first integrase inhibitor to gain FDA approval; but with limited evidence documenting long-term risks in real world care, especially for major health outcomes of interest. OBJECTIVE Assess raltegravir safety in clinical practice within an integrated health system. METHODS We conducted a cohort study of HIV-infected adults within Kaiser Permanente California from 2005 to 2013. We compared patients initiating raltegravir during the study period with two groups; a historical cohort (started new antiretroviral regimen [ART] 2005-2007) and a concurrent cohort that did not initiate raltegravir (2007-2013). We used multivariate Cox proportional hazard regression to obtain hazard ratios (HR) for pre-specified incident health outcomes, employing propensity scores to adjust for potential confounding. RESULTS The population included 8,219 HIV-infected adults (raltegravir cohort N = 1,757; 4,798 patient-years), with greater years known HIV-infected among raltegravir patients. The raltegravir cohort had increased HR for AIDS-defining (HR 2.69 [1.53-4.71]; HR 1.85 [1.21-2.82]) and non-AIDS-defining malignancies (HR 2.26 [1.29-3.94]; HR 1.88 [1.26-2.78]) relative to both comparison cohorts. Compared to the historical cohort we found no significant difference in all-cause mortality; the raltegravir cohort experienced increased HR for all-cause mortality compared to concurrent (HR 1.53 [1.02-2.31]). Raltegravir appeared protective of lipodystrophy when compared to the historical cohort but associated with increased incidence compared to concurrent. There were no significant differences in the incidence of hepatic, skin, or cardiovascular events. CONCLUSIONS The potentially elevated risk for malignancy and mortality with raltegravir and residual confounding merits further investigation. We demonstrate the value of observational cohorts for monitoring post-licensure medication safety.
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Affiliation(s)
- Michael A Horberg
- a Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States , Rockville , MD , USA
| | - Allison H Oakes
- b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Leo B Hurley
- c Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - William J Towner
- d Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Chun R Chao
- d Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Michael J Silverberg
- c Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Jean Q Chantra
- d Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Courtney G Ellis
- c Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
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de Miguel R, Montejano R, Stella-Ascariz N, Arribas JR. A safety evaluation of raltegravir for the treatment of HIV. Expert Opin Drug Saf 2017; 17:217-223. [PMID: 29199485 DOI: 10.1080/14740338.2018.1411903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Raltegravir (RAL) was the first commercialized agent from a new drug class with an innovative target, the integrase. Since its introduction in clinical practice RAL has become widely used for the treatment of HIV-1 infected patients. A decade after its approval, this article reviews key evidence from RAL with a special interest on safety outcomes. Areas covered: Pharmacologic, safety and efficacy data of RAL from clinical trials and post-commercialization published reports are hereby summarized after a literature review including PubMed search, relating proceedings and abstracts from relevant international HIV conferences, assessment reports from European and United States regulatory agencies and treatment guidelines (World Health Organization, United States Department of Health and Human Services and European AIDS Clinical Society), up to October 2017. Most frequent search terms were 'raltegravir', 'safety', 'adverse events', 'efficacy' and 'integrase-inhibitors'. Expert opinion: Despite the arrival of new integrase strand transfer inhibitors (INSTIs) with advantages in terms of dosing convenience (elvitegravir, ELV) and higher genetic barrier (dolutegravir, DTG), RAL has stood the test of time and its overall favourable safety profile, without significant appearance of unexpected adverse events, vouch for its relevance in the antiretroviral armamentarium.
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Affiliation(s)
- Rosa de Miguel
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Rocio Montejano
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Natalia Stella-Ascariz
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Jose R Arribas
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
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Singh KP, Crane M, Audsley J, Avihingsanon A, Sasadeusz J, Lewin SR. HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment. AIDS 2017; 31:2035-2052. [PMID: 28692539 PMCID: PMC5661989 DOI: 10.1097/qad.0000000000001574] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
: HIV infection has a significant impact on the natural history of chronic hepatitis B virus (HBV) infection, with increased levels of HBV DNA, accelerated progression of liver disease and increased liver-associated mortality compared with HBV monoinfection. Widespread uptake and early initiation of HBV-active antiretroviral therapy has substantially improved the natural history of HIV-HBV coinfection but the prevalence of liver disease remains elevated in this population. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV-HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease. We also review novel therapeutics for the management of HBV with a particular emphasis on clinical strategies being developed for an HBV cure and an HIV cure and their impact on HIV-HBV coinfected individuals.
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Affiliation(s)
- Kasha P Singh
- aThe Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital bVictorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity cDepartment of Infectious Diseases, Alfred Hospital and Monash University, Melbourne Australia dThai Red Cross AIDS Research Center and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Neukam K, Mira JA, Collado A, Rivero-Juárez A, Monje-Agudo P, Ruiz-Morales J, Ríos MJ, Merino D, Téllez F, Pérez-Camacho I, Gálvez-Contreras MC, Rivero A, Pineda JA. Liver Toxicity of Current Antiretroviral Regimens in HIV-Infected Patients with Chronic Viral Hepatitis in a Real-Life Setting: The HEPAVIR SEG-HEP Cohort. PLoS One 2016; 11:e0148104. [PMID: 26848975 PMCID: PMC4743911 DOI: 10.1371/journal.pone.0148104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/13/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To assess the current frequency of ART-associated grade 3-4 transaminase elevations (TE) and grade 4 total bilirubin elevations (TBE) in HIV-infected patients with chronic hepatitis B and/or C, who start a new regimen of ART. PATIENTS AND METHODS A total of 192 pre-treated or treatment-naive HIV infected patients with HBV and/or HCV-coinfection who started ART in eight Southern Spanish centers from July/2011-December/2013, were followed for 12 months in this prospective study. RESULTS Forty-one (21.4%) subjects had been naïve to ART, median (IQR) follow-up was 11.6 (5.6-12.9) months. The most frequently initiated NRTI were tenofovir/emtricitabine [49 patients (25.5%)]. Eighty-nine (46.4%) patients started a ritonavir-boosted protease inhibitor and 77 (40.1%) individuals a NNRTI. Raltegravir and maraviroc were initiated in 24 (12.5%) and 9 (4.7%) individuals. Ten [5.21%; 95% confidence interval (CI): 2.53%-9.37%] patients presented grade 3 TE, while 8 (4.17%; 95%CI: 1.82%-8.04%) subjects showed grade 4 TBE. No episodes of grade 4 TE or ART discontinuation due to hepatotoxic events were observed. The use of ritonavir-boosted atazanavir was the only independent predictor for grade 4 TBE [adjusted odds ratio: 7.327 (95%CI: 1.417-37.89); p = 0.018] in an analysis adjusted for age, sex and baseline HIV-RNA levels, while no factor could be independently associated with grade 3-4 TE. CONCLUSIONS Currently, the frequency of severe ART-associated TE and TBE under real-life conditions in patients with chronic viral hepatitis is similar to what has been reported previously. However, episodes of grade 4 TE are less frequent and severe TE appears to be of lesser concern.
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Affiliation(s)
- Karin Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - José A. Mira
- Internal Medicine Service, Hospital Universitario de Valme, Seville, Spain
| | - Antonio Collado
- Internal Medicine Department, Hospital Torrecárdenas, Almeria, Spain
| | | | - Patricia Monje-Agudo
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Josefa Ruiz-Morales
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Dolores Merino
- Internal Medicine Service, Hospital Juan Ramón Jiménez. Huelva, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital de La Línea de la Concepción, Cadiz, Spain
| | | | | | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Juan A. Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Supram HS, Gokhale S, Sathian B, Bhatta DR. Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Co-Infection Among HIV Infected Individuals at Tertiary Care Hospital in Western Nepal. Nepal J Epidemiol 2015; 5:488-93. [PMID: 26913208 DOI: 10.3126/nje.v5i2.12831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The HIV, HBV and HCV viruses are the major public health concern all over the world including Nepal. The aim of the study is to determine the rate of HBV and HCV co-infections in patients with HIV infection. METHODS The study cohort included 218 consecutive HIV infected patients who were examined for co-infection with HBV or HCV or both at Manipal teaching hospital, Western Nepal. The demographic data of the subjects was collected retrospectively. The data was analyzed with SPSS software and EPI Info to measure the correlation of variables and infection rates. RESULTS In the course of six years study period, a total of 25,708 samples were collected for HIV screening test. The 218 (0.8%) screen test positive for HIV were confirmed as per WHO guidelines. The overall rate of co-infection with HBV and or HCV was 7.3% (16 of 218 patients). Only 7 (3.2% [CI 1.3, 6.5]) were positive for both HIV and HBV infection markers and 9 (4.1% [CI 1.9, 7.7]) were positive for HIV and HCV infection markers. None were positive of all three virus markers. CONCLUSION It is advisable to implementregular screening for Hepatitis B Virus and Hepatitis C Virus among all HIV infected individuals and their sexual partners.
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Affiliation(s)
| | - Shishir Gokhale
- Department of Microbiology, Manipal College of Medical sciences , Pokhara, Nepal
| | - Brijesh Sathian
- Department of Community Medicine, Manipal College of Medical sciences , Pokhara, Nepal
| | - Dharma Raj Bhatta
- Department of Microbiology, Manipal College of Medical sciences , Pokhara, Nepal
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13
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Taramasso L, Madeddu G, Ricci E, De Socio GV, Menzaghi B, Orofino G, Passerini S, Franzetti M, Maggi P, Dentone C, Martinelli C, Celesia BM, Penco G, Libertone R, Quirino T, Bonfanti P, Di Biagio A. Raltegravir-based therapy in a cohort of HIV/HCV co-infected individuals. Biomed Pharmacother 2014; 69:233-6. [PMID: 25661363 DOI: 10.1016/j.biopha.2014.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/01/2014] [Indexed: 12/18/2022] Open
Abstract
The relationship between hepatic tolerance and hepatitis C virus (HCV) co-infection has not been extensively studied in clinical practice. We assessed the efficacy and safety of raltegravir-based therapy in an Italian cohort of HIV/HCV co-infected patients. One hundred and forty patients with HIV/HCV co-infection initiating raltegravir from SCOLTA project (Surveillance Cohort Long-Term Toxicity Antiretrovirals) were examined. Of them, 43 were women, with mean age of 45.4±6.4years; 65 (46%) had undetectable HIV-RNA<50copies/mL and 75 (54%) HIV-RNA≥50copies/mL. According to CDC classification, 49 (35%) were in stage C. Based on Fib4 score at the time of starting raltegravir, patients were classified in class I in 41 cases, class II in 68 and in class III in 31 cases. Globally, the Fib4 score slightly decreased during 24months follow-up, from 2.2 to a value of 1.8. Hepatic adverse events of any grade were observed in 67 patients, of which only 2 cases (3%) had severe liver toxicity (grade 3-4). Only one patient had to discontinue the therapy because of adverse events. According to univariate analysis, being in CDC stage C represented a risk for the development of liver toxicity, with a hazard ratio (HR) of 2.27 (95% CI 1.06-4.84, P=0.033). None of the other variables considered (age, sex, years since detection of HIV and HCV-RNA detectable, years of previous HIV therapy, concomitant therapy with PI or NRTI, CD4+ cell count, Fib4, and transaminases level at baseline) resulted statistically correlated to the outcome. In conclusion, raltegravir-based regimens can be safely used in HCV infected patients; in this study, the hepatic toxicity has been found to be more frequent in patients with an advanced HIV disease (CDC stage C), independently of HIV-RNA suppression at raltegravir initiation.
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Affiliation(s)
- L Taramasso
- University of Genova (DISSAL), Infectious Diseases Clinic, IRCCS AOU San Martino-IST, Genova, Italy.
| | - G Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - E Ricci
- Epi2004, Luigi Sacco Hospital, Milano, Italy
| | - G V De Socio
- Unit of Infectious Diseases, Santa Maria Hospital, Perugia, Italy
| | - B Menzaghi
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - G Orofino
- Department of Infectious Diseases, Amedeo Di Savoia Hospital, Torino, Italy
| | - S Passerini
- Department of Infectious Diseases, L. Sacco Hospital, University of Milano, Milano, Italy
| | - M Franzetti
- Department of Infectious Diseases, L. Sacco Hospital, University of Milano, Milano, Italy
| | - P Maggi
- Infectious Diseases Clinic, University Hospital Policlinico, Bari, Italy
| | - C Dentone
- Department of Infectious Diseases, Sanremo Hospital, Sanremo, Italy
| | - C Martinelli
- Unit of Infectious Diseases, Careggi Hospital, Firenze, Italy
| | - B M Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy
| | - G Penco
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - R Libertone
- National Institute of Infectious Diseases "L. Spallanzani", Roma, Italy
| | - T Quirino
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - P Bonfanti
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - A Di Biagio
- Infectious Disease Clinic, IRCCS AOU San Martino-IST, Genova, Italy.
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14
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A switch to Raltegravir improves antiretroviral associated hepatotoxicity in individuals co-infected with HIV and hepatitis C. J Infect 2014; 69:190-3. [PMID: 24793307 DOI: 10.1016/j.jinf.2014.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/14/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Raltegravir is a switch option for HIV/HCV co-infected individuals due to its hepatic neutral profile. We evaluated the effect of a switch to Raltegravir from other antiretroviral agents in HIV and HCV-co-infected individuals naïve to HCV therapy. METHODS Observational, single-centre study. Data on alanine aminotransferase levels, HCV-VL, CD4 cell count, HIV viral load levels and hepatic fibrosis score were collated six months pre-switch, at the time of switch and six months post switch to Raltegravir therapy. Results were compared utilizing the Kruskal-Wallis test. RESULTS Twenty-seven individuals were identified. Median age was 43 years, median duration of HIV infection was 7 years and median documented period of HCV infection at the time of switch was 26 months. A sustained improvement in ALT levels was observed. Median ALT levels were 254 IU/L at the time of switch, decreasing significantly to 176 IU/L, (p = 0.0226) and 90 IU/L (p = 0.0138) 1 month post switch and 6 months post switch respectively. The median Hepatitis C viral load level at the time of the switch was 341,783 copies/mL, which decreased to 224,066 copies/mL 6 months after switch (p = 0.04). DISCUSSION A switch to Raltegravir in individuals with HIV/HCV co-infection was effective in maintaining HIV virological suppression with improvement in drug-associated hepatotoxicity as measured by ALT.
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