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JAC Advance Access published online on November 9, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl447
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received June 4, 2006
Revised September 26, 2006
Accepted October 10, 2006

Original article

Low-level liver enzyme elevations during HAART are not associated with liver fibrosis progression among HIV/HCV-coinfected patients

Salvador Vergara 1, Juan Macías 2 *, José A. Mira 2, José A. García-García 1, Nicolás Merchante 1, José del Valle 1, Laila Abdel-Kader 1, Fernando Lozano 1, Jesús M. Gómez-Mateos 1, and Juan A. Pineda 1

1 Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Valme, Seville, Spain

* To whom correspondence should be addressed.
Juan Macías, E-mail: jmacias{at}cica.es


  Abstract

Objectives: To assess the association between non-severe liver enzyme elevations (LEEs) during antiretroviral treatment and liver fibrosis in HIV/HCV-coinfected patients.

Methods: All co-infected patients from an Infectious Disease Unit who had received treatment with highly active antiretroviral therapy (HAART) for at least 12 months before undergoing a liver biopsy were included in the study.

Results: One-hundred and sixteen patients met the inclusion criteria of the study. Advanced liver fibrosis was observed in 32 (38%) of 84 patients who developed non-severe LEEs and in 11 (34%) of 32 subjects who developed severe (grade ≥ 3) LEEs, (P = 0.7). Seven (6%) of 116 patients showed grade 3 or 4 LEEs for at least 30% of the follow-up. Advanced liver fibrosis was observed in five (71%) of these patients and in 38 (35%) of the 109 subjects who did not develop long-term severe LEEs (P = 0.05). Eight (10%) of 84 patients showed grade 2 LEEs for at least 30% of the follow-up. Advanced liver fibrosis was observed in 28 (37%) of 76 subjects who did not develop long-term grade 2 LEEs and in three (38%) of eight patients who developed them (P = 0.9).

Conclusions: In HIV/HCV-coinfected patients, non-severe LEEs, whether persistent or not, are not associated with advanced liver fibrosis. On the other hand, long-term severe LEEs are associated with more severe liver fibrosis in this population.

Keywords: hepatotoxicity; HIV/HCV coinfection; antiretroviral agents; highly active antiretroviral therapy.
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