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AASLD: HIV Patients Have Liver Damage on Antiretroviral Therapies By Jane Salodof MacNeil BOSTON, MA -- October 31, 2003 -- Antiretroviral therapies are causing high rates of liver damage and liver-related death in HIV-positive patients whose lives depend on their tolerating these regimens. One in 10 HIV-positive patients on antiretroviral therapy (ART) develops severe, grade 3 or higher hepatotoxicity, and 3% die of liver-related causes, according to data presented October 26th at the 54th Annual Meeting of the American Association for the Study of Liver Diseases. The 9,071-patient sample is described as the largest HIV cohort ever studied in the United States. The death rate overall was 13%, and 24% of patients discontinued ART. Julie C. Servoss, MD, Massachusetts General Hospital, Boston, United States, presented the data, which were pooled from 21 Adult AIDS Clinical Trials Group (AACTG) studies conducted from 1991 to 2000. Dr. Servoss said that ART had transformed HIV infection from a potentially fatal condition to a chronic disease, but that liver toxicity was a serious problem. While the findings confirmed the association between ART and liver damage, the researchers raised hope that physicians will be able to identify patients who are predisposed to hepatoxicity, and adjust their treatments. "Renal insufficiency, thrombocytopaenia, and the concomitant use of hepatotoxic medications should be considered before the administering of ART," Dr. Servoss said, reporting on risk factors identified in the study. The investigators identified factors that predicted hepatoxicity in patients on single and multiple nucleoside transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibiors (NNRTI) and the protease inhibitor indinavir. For all regimens, high baseline aspartate aminotransferase (AST) and/or serum alanine aminotransferase (ALT) levels were associated with severe hepatotoxicity. NNRTI-based regimens containing nevirapine also had higher toxicity levels early and later in the course of treatment. Late severe hepatoxicity was associated with high triglyceride counts in patients on single-NRTI regimens. The group identified several risk factors that had not been previously reported for patients on multiple NRTIs. These included platelets <99,000/mm3, creatinine > 1.5xULN, and use of other hepatotoxic medications. For patients on indinavir-based regimens, the researchers found use of stavudine (Zerit) and history of intravenous drug use were predictors of severe hepatotoxicity, as was concurrent use of medication toxic to the liver. "These findings suggest that in addition to baseline ALT and AST, other factors should be considered prior to initiating ART," they concluded. [Study Title: Predictors of Antiretroviral-Related Hepatoxicity in the Adult AIDS Clinical Trials Group (AACTG). Abstract 70] E-mail this page to a friend or colleague! To print, use this version