In:
Journal of Viral Hepatitis, Wiley, Vol. 18, No. 7 ( 2011-07)
Abstract:
Summary. The impact of antiretroviral drug exposure and associated lipodystrophy and/or insulin resistance (IR) on advanced liver fibrosis in HIV/HCV‐coinfected patients is not fully documented. We determined the prevalence of advanced liver fibrosis (defined by hepatic stiffness ≥9.5 kPa) and associated factors, focusing on the impact of highly active antiretroviral therapy and its major adverse effects (lipodystrophy and IR), in 671 HIV/HCV‐coinfected patients included in the ANRS CO13 HEPAVIH cohort. One hundred ninety patients (28.3%) had advanced liver fibrosis. In univariate analysis, advanced liver fibrosis was significantly associated with male sex, higher body mass index, HCV infection through intravenous drug use, a lower absolute CD4 cell count, a longer history of antiretroviral treatment, longer durations of protease inhibitors, non‐nucleoside reverse transcriptase inhibitors and NRTI exposure, lipodystrophy, diabetes, and a high homeostasis model assessment method (HOMA) value. The only antiretroviral drugs associated with advanced liver fibrosis were efavirenz, stavudine and didanosine. In multivariate analysis, male sex (OR 2.0, 95% CI 1.1–3.5; P = 0.018), HCV infection through intravenous drug use (OR 2.0, 95% CI 1.1–3.6; P = 0.018), lipodystrophy (OR 2.0, 95% CI 1.2–3.3; P = 0.01), median didanosine exposure longer than 5 months (OR 1.7, 95% CI 1.0–2.8; P = 0.04) and a high HOMA value (OR 1.1, 95% CI 1.0–1.2; P = 0.005) remained significantly associated with advanced liver fibrosis. Mitochondrial toxicity and IR thus appear to play a key role in liver damage associated with HIV/HCV‐coinfection, and this should be taken into account when selecting and optimizing antiretroviral therapy. Antiretroviral drugs with strong mitochondrial toxicity (e.g. didanosine) or a major effect on glucose metabolism should be avoided.
Type of Medium:
Online Resource
ISSN:
1352-0504
,
1365-2893
DOI:
10.1111/jvh.2011.18.issue-7
DOI:
10.1111/j.1365-2893.2010.01417.x
Language:
English
Publisher:
Wiley
Publication Date:
2011
detail.hit.zdb_id:
2007924-2
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