Abstract
Objectives: To assess incidence, risk factors, histology, and outcome of severe hepatotoxicity (SH) during antiretroviral treatment (ART). Methods: Seven hundred fifty-five HIV-seropositive patients consecutively prescribed new ART were selected. Liver function tests were assessed at baseline, after 1 month, and every 4 months thereafter. Liver biopsy was recommended in case of SH (i.e., increase in liver enzymes ≥10 times the upper limit of normal or 5 times baseline if markedly abnormal). Results: Twenty-six cases of SH were observed with an incidence of 4.2% person-years. Liver failure (LF) was rarely seen (1.1 per 100 person-years). Liver damage was invariably observed in patients with chronic viral hepatitis. Liver histology showed exacerbation of viral hepatitis in all 16 patients for whom a liver biopsy was available at the time of SH. A direct correlation was found between alanine aminotransferase increase and increase in CD4+ T-cell count in patients with SH (r = 0.53, p <.001). Death occurred during follow-up in 7 of 26 (27%) patients, all of whom showed LF and baseline CD4+ count less than 200 cells/mm3 (7/7 patients = 100% vs. 8/19 patients without LF; p <.01). Relapse of SH was observed after ART was recommenced in 7 of 17 (41%) patients. Five of these 7 patients did not show further SH relapse after treatment with interferon. Conclusions: This study provides estimates of SH and LF in a large populationbased setting where hepatitis C virus coinfection is highly prevalent and provides indications that liver damage may be caused by immune reconstitution and related exacerbation of viral hepatitis. A strict follow-up for hepatotoxicity is mandatory when ART is initiated in patients with + T cells/mm3. Antihepatitis pre- or comedication could be an effective preventive or curative measure.
| Original language | English |
|---|---|
| Pages (from-to) | 259-267 |
| Number of pages | 9 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 32 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2003 |
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Keywords
- Antiretroviral treatment
- Histology
- Immune reconstitution
- Interferon
- Liver damage
ASJC Scopus subject areas
- Virology
- Immunology
Cite this
Severe hepatotoxicity during combination antiretroviral treatment : Incidence, liver histology, and outcome. / Puoti, Massimo; Torti, Carlo; Ripamonti, Diego; Castelli, Francesco; Zaltron, Serena; Zanini, Barbara; Spinetti, Angiola; Putzolu, Valeria; Casari, Salvatore; Tomasoni, Lina; Quiros-Roldan, Eugenia; Favret, Maurizio; Berchich, Luisa; Grigolato, Piergiovanni; Callea, Francesco; Carosi, Giampiero.
In: Journal of Acquired Immune Deficiency Syndromes, Vol. 32, No. 3, 03.2003, p. 259-267.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Severe hepatotoxicity during combination antiretroviral treatment
T2 - Incidence, liver histology, and outcome
AU - Puoti, Massimo
AU - Torti, Carlo
AU - Ripamonti, Diego
AU - Castelli, Francesco
AU - Zaltron, Serena
AU - Zanini, Barbara
AU - Spinetti, Angiola
AU - Putzolu, Valeria
AU - Casari, Salvatore
AU - Tomasoni, Lina
AU - Quiros-Roldan, Eugenia
AU - Favret, Maurizio
AU - Berchich, Luisa
AU - Grigolato, Piergiovanni
AU - Callea, Francesco
AU - Carosi, Giampiero
PY - 2003/3
Y1 - 2003/3
N2 - Objectives: To assess incidence, risk factors, histology, and outcome of severe hepatotoxicity (SH) during antiretroviral treatment (ART). Methods: Seven hundred fifty-five HIV-seropositive patients consecutively prescribed new ART were selected. Liver function tests were assessed at baseline, after 1 month, and every 4 months thereafter. Liver biopsy was recommended in case of SH (i.e., increase in liver enzymes ≥10 times the upper limit of normal or 5 times baseline if markedly abnormal). Results: Twenty-six cases of SH were observed with an incidence of 4.2% person-years. Liver failure (LF) was rarely seen (1.1 per 100 person-years). Liver damage was invariably observed in patients with chronic viral hepatitis. Liver histology showed exacerbation of viral hepatitis in all 16 patients for whom a liver biopsy was available at the time of SH. A direct correlation was found between alanine aminotransferase increase and increase in CD4+ T-cell count in patients with SH (r = 0.53, p <.001). Death occurred during follow-up in 7 of 26 (27%) patients, all of whom showed LF and baseline CD4+ count less than 200 cells/mm3 (7/7 patients = 100% vs. 8/19 patients without LF; p <.01). Relapse of SH was observed after ART was recommenced in 7 of 17 (41%) patients. Five of these 7 patients did not show further SH relapse after treatment with interferon. Conclusions: This study provides estimates of SH and LF in a large populationbased setting where hepatitis C virus coinfection is highly prevalent and provides indications that liver damage may be caused by immune reconstitution and related exacerbation of viral hepatitis. A strict follow-up for hepatotoxicity is mandatory when ART is initiated in patients with + T cells/mm3. Antihepatitis pre- or comedication could be an effective preventive or curative measure.
AB - Objectives: To assess incidence, risk factors, histology, and outcome of severe hepatotoxicity (SH) during antiretroviral treatment (ART). Methods: Seven hundred fifty-five HIV-seropositive patients consecutively prescribed new ART were selected. Liver function tests were assessed at baseline, after 1 month, and every 4 months thereafter. Liver biopsy was recommended in case of SH (i.e., increase in liver enzymes ≥10 times the upper limit of normal or 5 times baseline if markedly abnormal). Results: Twenty-six cases of SH were observed with an incidence of 4.2% person-years. Liver failure (LF) was rarely seen (1.1 per 100 person-years). Liver damage was invariably observed in patients with chronic viral hepatitis. Liver histology showed exacerbation of viral hepatitis in all 16 patients for whom a liver biopsy was available at the time of SH. A direct correlation was found between alanine aminotransferase increase and increase in CD4+ T-cell count in patients with SH (r = 0.53, p <.001). Death occurred during follow-up in 7 of 26 (27%) patients, all of whom showed LF and baseline CD4+ count less than 200 cells/mm3 (7/7 patients = 100% vs. 8/19 patients without LF; p <.01). Relapse of SH was observed after ART was recommenced in 7 of 17 (41%) patients. Five of these 7 patients did not show further SH relapse after treatment with interferon. Conclusions: This study provides estimates of SH and LF in a large populationbased setting where hepatitis C virus coinfection is highly prevalent and provides indications that liver damage may be caused by immune reconstitution and related exacerbation of viral hepatitis. A strict follow-up for hepatotoxicity is mandatory when ART is initiated in patients with + T cells/mm3. Antihepatitis pre- or comedication could be an effective preventive or curative measure.
KW - Antiretroviral treatment
KW - Histology
KW - Immune reconstitution
KW - Interferon
KW - Liver damage
UR - http://www.scopus.com/inward/record.url?scp=0037342098&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037342098&partnerID=8YFLogxK
U2 - 10.1097/00126334-200303010-00004
DO - 10.1097/00126334-200303010-00004
M3 - Article
C2 - 12626885
AN - SCOPUS:0037342098
VL - 32
SP - 259
EP - 267
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
IS - 3
ER -