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Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
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HAART and liver: is it safe?
Vicente Sperb Antonello1, Dimas Alexandre Kliemann, Breno Rigel Santos
1Hospital Fêmina, Porto Alegre, RS, Brasil. vicente_antonello@hotmail.com.
Journal of Infection in Developing Countries
|November 13, 2014
Summary
Hepatitis C virus (HCV) coinfection significantly increases the risk of liver damage (hepatotoxicity) in HIV patients starting highly active antiretroviral therapy (HAART). However, HAART benefits outweigh these risks, rarely necessitating treatment discontinuation.
Area of Science:
- Hepatology
- Infectious Diseases
- HIV Medicine
Background:
- Hepatitis C virus (HCV) infection is a significant cause of liver disease and morbidity in patients with human immunodeficiency virus (HIV).
- The initiation of highly active antiretroviral therapy (HAART) for HIV management can impact liver function, particularly in coinfected individuals.
Purpose of the Study:
- To investigate whether chronic HCV infection elevates the risk of hepatotoxicity following HAART initiation.
- To assess and compare the incidence and risk of liver injury in HIV/HCV coinfected versus HIV-monoinfected patients receiving HAART.
Main Methods:
- A comparative analysis of 30 HIV/HCV coinfected and 35 HIV-monoinfected patients was conducted.
- Clinical and laboratory evaluations, including transaminase levels, were performed every three months for twelve months post-HAART initiation.
Main Results:
- Pre-HAART, coinfected patients exhibited higher transaminase levels (p < 0.001).
- Post-HAART, coinfected patients consistently showed elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels.
- Hepatotoxicity occurred in 73% of coinfected patients versus 20% of monoinfected patients, with a 3.7 times higher risk in the coinfected group (RR 3.7 [1.8-7.4], p < 0.001).
Conclusions:
- HIV/HCV coinfected patients face a substantially increased risk of developing hepatotoxicity when initiating HAART.
- Despite the elevated risk, the clinical and immunological advantages of HAART generally supersede the risks of liver injury, making treatment discontinuation uncommon.
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