Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection

Marieke Den Brinker, Ferdinand W.N.M. Wit, Pauline M.E. Wertheim-van Dillen, Suzanne Jurriaans, Jan Weel, Remko Van Leeuwen, Nadine G. Pakker, Peter Reiss, Sven A. Danner, Gerrit Jan Weverling, Joep M.A. Lange*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To investigate the risk of hepatotoxicity after initiation of prolease inhibitor-containing highly active antiretroviral therapy (HAART) for HIV-1 infected patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infection. Design: Retrospective study with 394 HIV-1-infected patients initiating HAART at a single university clinic. Methods: Liver enzyme elevation (LEE) was defined as alanine aminotransferase or aspartate aminotransferase at least five times the upper limit of normal and an absolute increase of > 100 U/l. Relative risks for time to LEE were estimated using Cox proportional hazards models. Results: Of 394 patients 7% were hepatitis B surface antigen (HBsAg)-positive and 14% were anti-HCV-positive. Patients with chronic hepatitis had a higher risk for LEE compared with patients without co-infection: 37% versus 12% respectively. After adjustment for higher baseline transaminases, the presence of HBsAg or anti-HCV remained associated with an increased risk of LEE - relative risk 2.78 (95% confidence interval, 1.50-5.16) and 2.46 (95% confidence interval, 1.43-4.24) respectively. In patients with LEE, transaminases declined whether HAART was continued or modified. Of patients with chronic HBV infection 38% lost HBeAg or developed anti-HBe after initiation of HAART, and one seroconverted from HBsAg-positive to anti-HBs-positive. However, there was no clear relationship with LEE. Conclusions: HIV-1-infected patients co-infected wilh HBV or HCV were at considerably higher risk of developing LEE when HAART was initiated compared with patients withoul co-infection, but it is usually not necessary to modify antiretroviral therapy.

Original languageEnglish
Pages (from-to)2895-2902
Number of pages8
Issue number18
Publication statusPublished - 2000

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