Lopinavir/ritonavir treatment in HIV antiretroviral-experienced patients: Evaluation of risk factors for liver enzyme elevation

Paola Meraviglia, M. Schiavini, A. Castagna, P. Viganò, T. Bini, S. Landonio, A. Danise, M. C. Moioli, E. Angeli, M. Bongiovanni, H. Hasson, P. Duca, A. Cargnel

Research output: Contribution to journalArticle

Abstract

Objectives. To evaluate the risk factors for lopinavir/ritonavir (LPV/r)-related liver enzyme elevation (LEE) in HIV antiretroviral-experienced patients. Methods. An open prospective observational study was carried out to analyse the incidence and time of LEE development during LPV/r treatment, and to determine whether LEE development was correlated with epidemiological, clinical and biochemical data, immune and virological profiles, concomitant hepatic diseases, antiretroviral therapy, or histological and ultrasonography liver examination results. A diagnosis of LEE was considered when LEE symptoms occurred after LPV/r introduction and was confirmed by a second control within 2 weeks. Results. A total of 782 HIV-positive outpatients have been enrolled in six different Infectious Diseases Departments in Northern Italy since August 2000. Of these patients, 71 (9.1%) developed LEE within 115 ± 85 days (mean ± standard deviation); 13 of these subjects discontinued LPV/r and four were hospitahzed. Of the patients with LEE, 74.6% and 25.4% had grade 2 and ≥3 toxicity, respectively. No correlation between LEE and sex, baseline CD4 cell count, viral load, HIV stage, triglyceride values, histological and ultrasonography liver examination results, nevirapine use, or increase in CD4 cell count was observed. Higher baseline alanine aminotransferase (ALT) and γ -glutamyltransferase (GGT) values (P <0.0001 and P = 0.004, respectively), younger age (P = 0.008), previous hepatitis B virus (HBV) infection (P = 0.012), efavirenz use (P = 0.04), and hepatitis C virus (HCV) and/or HBV coinfection (P <0.0001, relative risk 4.78) were significantly related to LEE. No correlations between LEE and the same risk factors as investigated in the whole study population were found in subgroups of patients with HCV and/or HBV infection. Conclusions. HCV and HBV testing and measurement of baseline ALT values are essential for screening subjects at risk of LEE before starting LPV/r. Strict monitoring of clinical and biochemical parameters should be performed in these patents.

Original languageEnglish
Pages (from-to)334-343
Number of pages10
JournalHIV Medicine
Volume5
Issue number5
DOIs
Publication statusPublished - Sep 2004

Keywords

  • Liver enzyme elevation
  • Lopinavir/ritonavir
  • Viral hepatitis coinfection

ASJC Scopus subject areas

  • Virology
  • Medicine(all)
  • Immunology

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    Meraviglia, P., Schiavini, M., Castagna, A., Viganò, P., Bini, T., Landonio, S., Danise, A., Moioli, M. C., Angeli, E., Bongiovanni, M., Hasson, H., Duca, P., & Cargnel, A. (2004). Lopinavir/ritonavir treatment in HIV antiretroviral-experienced patients: Evaluation of risk factors for liver enzyme elevation. HIV Medicine, 5(5), 334-343. https://doi.org/10.1111/j.1468-1293.2004.00232.x