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Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon

BACKGROUND: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis,...

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Autores principales: Mbougua, Jules B Tchatchueng, Laurent, Christian, Kouanfack, Charles, Bourgeois, Anke, Ciaffi, Laura, Calmy, Alexandra, Gwet, Henri, Koulla-Shiro, Sinata, Ducos, Jacques, Mpoudi-Ngolé, Eitel, Molinari, Nicolas, Delaporte, Eric
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841671/
https://www.ncbi.nlm.nih.gov/pubmed/20193053
http://dx.doi.org/10.1186/1471-2458-10-105
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author Mbougua, Jules B Tchatchueng
Laurent, Christian
Kouanfack, Charles
Bourgeois, Anke
Ciaffi, Laura
Calmy, Alexandra
Gwet, Henri
Koulla-Shiro, Sinata
Ducos, Jacques
Mpoudi-Ngolé, Eitel
Molinari, Nicolas
Delaporte, Eric
author_facet Mbougua, Jules B Tchatchueng
Laurent, Christian
Kouanfack, Charles
Bourgeois, Anke
Ciaffi, Laura
Calmy, Alexandra
Gwet, Henri
Koulla-Shiro, Sinata
Ducos, Jacques
Mpoudi-Ngolé, Eitel
Molinari, Nicolas
Delaporte, Eric
author_sort Mbougua, Jules B Tchatchueng
collection PubMed
description BACKGROUND: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-HIV treatment. We compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with HIV only and patients coinfected with hepatitis B or C virus in Cameroon. METHODS: A retrospective cohort study was conducted among HIV-1-infected patients. Plasma HBV DNA and HCV RNA were tested in positive or indeterminate samples for HBsAg or HCV antibodies, respectively. All patients received nevirapine and lamivudine plus stavudine or zidovudine. RESULTS: Of 169 HIV-1-infected patients with a median baseline CD4 count of 135 cells/mm(3 )(interquartile range [IQR] 67-218), 21% were coinfected with HBV or HCV. In coinfected patients, the median viral load was 2.47 × 10(7 )IU/mL for HBV (IQR 3680-1.59 × 10(8)) and 928 000 IU/mL for HCV (IQR 178 400-2.06 × 10(6)). Multivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). The response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of CD4 cell count increase (p = 0.8), HIV-1 viral load below 400 copies/mL (p = 0.9), death (p = 0.3) and death or new AIDS-defining event (p = 0.1). Nevirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. CONCLUSION: This study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low CD4 cell count in Africa despite frequent coinfections with HBV or HCV and infrequent testing of these infections. Although testing for HBV and HCV should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown.
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spelling pubmed-28416712010-03-19 Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon Mbougua, Jules B Tchatchueng Laurent, Christian Kouanfack, Charles Bourgeois, Anke Ciaffi, Laura Calmy, Alexandra Gwet, Henri Koulla-Shiro, Sinata Ducos, Jacques Mpoudi-Ngolé, Eitel Molinari, Nicolas Delaporte, Eric BMC Public Health Research article BACKGROUND: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-HIV treatment. We compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with HIV only and patients coinfected with hepatitis B or C virus in Cameroon. METHODS: A retrospective cohort study was conducted among HIV-1-infected patients. Plasma HBV DNA and HCV RNA were tested in positive or indeterminate samples for HBsAg or HCV antibodies, respectively. All patients received nevirapine and lamivudine plus stavudine or zidovudine. RESULTS: Of 169 HIV-1-infected patients with a median baseline CD4 count of 135 cells/mm(3 )(interquartile range [IQR] 67-218), 21% were coinfected with HBV or HCV. In coinfected patients, the median viral load was 2.47 × 10(7 )IU/mL for HBV (IQR 3680-1.59 × 10(8)) and 928 000 IU/mL for HCV (IQR 178 400-2.06 × 10(6)). Multivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). The response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of CD4 cell count increase (p = 0.8), HIV-1 viral load below 400 copies/mL (p = 0.9), death (p = 0.3) and death or new AIDS-defining event (p = 0.1). Nevirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. CONCLUSION: This study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low CD4 cell count in Africa despite frequent coinfections with HBV or HCV and infrequent testing of these infections. Although testing for HBV and HCV should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown. BioMed Central 2010-03-01 /pmc/articles/PMC2841671/ /pubmed/20193053 http://dx.doi.org/10.1186/1471-2458-10-105 Text en Copyright ©2010 Mbougua et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research article
Mbougua, Jules B Tchatchueng
Laurent, Christian
Kouanfack, Charles
Bourgeois, Anke
Ciaffi, Laura
Calmy, Alexandra
Gwet, Henri
Koulla-Shiro, Sinata
Ducos, Jacques
Mpoudi-Ngolé, Eitel
Molinari, Nicolas
Delaporte, Eric
Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title_full Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title_fullStr Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title_full_unstemmed Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title_short Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon
title_sort hepatotoxicity and effectiveness of a nevirapine-based antiretroviral therapy in hiv-infected patients with or without viral hepatitis b or c infection in cameroon
topic Research article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841671/
https://www.ncbi.nlm.nih.gov/pubmed/20193053
http://dx.doi.org/10.1186/1471-2458-10-105
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