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No increased risk of hepatotoxicity in long‐term use of nonnucleoside reverse transcriptase inhibitors in HIV ‐infected patients
Author(s) -
Welzen BJ,
Mudrikova T,
Arends JE,
Hoepelman AIM
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2012.00995.x
Subject(s) - nevirapine , medicine , efavirenz , reverse transcriptase inhibitor , regimen , gastroenterology , odds ratio , simeprevir , confidence interval , hepatitis c virus , viral load , human immunodeficiency virus (hiv) , immunology , ribavirin , antiretroviral therapy , virus
Objective The aim of this study was to assess the incidence of hepatotoxicity in patients who had used nonnucleoside reverse transcriptase inhibitors ( NNRTIs ) for at least 3 years. Methods The study group consisted of HIV ‐infected patients under follow‐up at our clinic, who had continuously used an NNRTI ‐containing regimen (efavirenz or nevirapine) for at least 3 years. Patients who had used protease inhibitors ( PI s) for the same time span constituted a control group. Hepatotoxicity was graded according to the modified AIDS C linical T rial G roup grading system, using alanine aminotransferase ( ALT ) as a marker. Results One hundred and twenty‐two patients on an NNRTI regimen and 54 PI ‐using patients were included in the analysis. The mean follow‐up time was nearly 6 years. Eighteen NNRTI ‐using patients (14.8%) developed a clinically relevant (≥ grade II ) event of hepatotoxicity during treatment; five of them (4.1%) developed severe hepatotoxicity (≥ grade III ). No significant difference in the hepatotoxicity rate was seen between NNRTI ‐ and PI ‐using patients (14.8 vs. 18.5%, respectively; P = 0.52) or between patients using efavirenz and nevirapine (13.8% vs. 16.7%, respectively; P = 0.51). A hepatitis C virus ( HCV ) coinfection was associated with an increased risk of the development of hepatotoxicity during NNRTI therapy [odds ratio ( OR ) 1.83; 95% confidence interval ( CI ) 1.33–4.24; P < 0.01]. Finally, we observed that more hepatotoxic events occurred during the first year of NNRTI therapy compared with the entire period after 1 year (6.6 vs. 2.8 events, respectively, per 100 person‐years of treatment; P = 0.04). Conclusions Long‐term NNRTI use was not associated with a higher risk of clinically significant liver toxicity in patients who had been treated with NNRTI for at least 3 years.