Epidemiology

Antiretroviral therapy not linked to serious liver toxicity

Last Updated: 2012-11-07 18:05:27 -0400 (Reuters Health)

By C. Vidya Shankar MD

NEW YORK (Reuters Health) - Long-term antiretroviral therapy for HIV doesn't increase hepatotoxicity-related mortality in patients free of hepatitis B and C, a multi-center study shows.

Lead investigator Dr. Helen Kovari of University Hospital Zurich told Reuters Health in an email, "It is important to know that the incidence of life-threatening hepatotoxic side effects due to antiretroviral treatment is very low."

Co-infections with hepatitis C virus (HCV) or hepatitis B virus (HBV) and alcohol-related liver damage are major contributors to non-AIDS mortality in HIV patients, the researchers pointed out October 22 online in Clinical Infectious Diseases.

But "little is known about other causes," they wrote.

Their prospective cohort study followed 22,910 HIV patients who were HCV- and HBV-negative from 1999-2010, for 114,478 patient-years.

Patients were enrolled in the Data Collection on Adverse Events of Anti HIV Drug (D:A:D) cohort study, which involves 212 clinics in Europe, the U.S., and Australia.

Clinical examination, HCV and HBV testing, and measurement of HIV viral loads were done at regular intervals.

"The incidence of liver related deaths was very low," the researchers observed. Overall, among the 1,059 deaths during the study period, 12 (0.05%) were due to liver disease (0.1 per 1,000 person years).

The authors say these figures were similar to the liver disease related mortality of 0.16 per 1,000 patient years among HCV-negative patients in general population as document by the American NHANES III study.

ART-related hepatotoxicity contributed to five deaths (0.04 per 1000 person-years. Didanosine- and stavudine-induced acute liver failure and lactic acidosis and didanosine-related non-cirrhotic portal hypertension were responsible for two deaths each, while hypersensitivity to nevirapine contributed to one liver-related death.

"This is the first large study assessing liver-related deaths in HCV or HBV sero-negative patients," Dr. Kovari emphasized.

The researchers say they couldn't perform a multivariate analysis of the associated risk factors because of the rarity of the end-points.

"This is good news in times in which HIV infection has evolved into a chronic disease" needing long term ART, the research team concluded.

SOURCE: http://bit.ly/RJesHU

Clin Infect Dis 2012.