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Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?
OBJECTIVE: Hyperbilirubinaemia (HB) is common in HIV and hepatitis C virus (HIV–HCV) co-infected patients and poses a unique challenge in management as it may be due to medications such as the protease inhibitors (PIs) or to hepatic dysfunction. There are no data on the relationship of HB to liver h...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780040/ https://www.ncbi.nlm.nih.gov/pubmed/26966552 http://dx.doi.org/10.1136/bmjgast-2015-000072 |
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author | Kaspar, Matthew B Sterling, Richard K |
author_facet | Kaspar, Matthew B Sterling, Richard K |
author_sort | Kaspar, Matthew B |
collection | PubMed |
description | OBJECTIVE: Hyperbilirubinaemia (HB) is common in HIV and hepatitis C virus (HIV–HCV) co-infected patients and poses a unique challenge in management as it may be due to medications such as the protease inhibitors (PIs) or to hepatic dysfunction. There are no data on the relationship of HB to liver histology and PI use in this population. Clinicians caring for these patients are faced with the difficult task of determining whether increasing serum bilirubin is due to drug effects or progression of liver disease. METHODS: To address this gap in knowledge, we performed a retrospective analysis of 344 consecutive HIV–HCV co-infected patients undergoing liver biopsy to identify factors associated with HB. Demographic, clinical, laboratory data were collected. Advanced fibrosis was defined as bridging fibrosis or cirrhosis. Those with hepatitis B virus, hepatic decompensation or hepatocellular carcinoma were excluded. RESULTS: The prevalence of HB (range 1.3–9.4) was 33% and more common in those on a PI (46%) than those who were not (10%; p≤0.001) and mostly in those on indinavir (40%) or atazanavir (46%). Of the patients on these PIs, HB was not associated with fibrosis grade, demographics, or other clinical variables. Conversely, in those not on a PI, HB was associated with fibrosis grade (p≤0.0001) after adjusting for other clinical and demographic variables. CONCLUSIONS: In the setting of indinavir or atazanavir use, HB is common and unrelated to underlying disease severity and the medications can be continued safely. Conversely, HB in HIV–HCV co-infected patients not on a PI is due to their underlying liver disease and suggests these patients require closer monitoring. |
format | Online Article Text |
id | pubmed-4780040 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-47800402016-03-10 Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? Kaspar, Matthew B Sterling, Richard K BMJ Open Gastroenterol Hepatology OBJECTIVE: Hyperbilirubinaemia (HB) is common in HIV and hepatitis C virus (HIV–HCV) co-infected patients and poses a unique challenge in management as it may be due to medications such as the protease inhibitors (PIs) or to hepatic dysfunction. There are no data on the relationship of HB to liver histology and PI use in this population. Clinicians caring for these patients are faced with the difficult task of determining whether increasing serum bilirubin is due to drug effects or progression of liver disease. METHODS: To address this gap in knowledge, we performed a retrospective analysis of 344 consecutive HIV–HCV co-infected patients undergoing liver biopsy to identify factors associated with HB. Demographic, clinical, laboratory data were collected. Advanced fibrosis was defined as bridging fibrosis or cirrhosis. Those with hepatitis B virus, hepatic decompensation or hepatocellular carcinoma were excluded. RESULTS: The prevalence of HB (range 1.3–9.4) was 33% and more common in those on a PI (46%) than those who were not (10%; p≤0.001) and mostly in those on indinavir (40%) or atazanavir (46%). Of the patients on these PIs, HB was not associated with fibrosis grade, demographics, or other clinical variables. Conversely, in those not on a PI, HB was associated with fibrosis grade (p≤0.0001) after adjusting for other clinical and demographic variables. CONCLUSIONS: In the setting of indinavir or atazanavir use, HB is common and unrelated to underlying disease severity and the medications can be continued safely. Conversely, HB in HIV–HCV co-infected patients not on a PI is due to their underlying liver disease and suggests these patients require closer monitoring. BMJ Publishing Group 2016-03-02 /pmc/articles/PMC4780040/ /pubmed/26966552 http://dx.doi.org/10.1136/bmjgast-2015-000072 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Hepatology Kaspar, Matthew B Sterling, Richard K Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title | Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title_full | Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title_fullStr | Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title_full_unstemmed | Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title_short | Hyperbilirubinaemia in HIV–HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
title_sort | hyperbilirubinaemia in hiv–hcv co-infected patients on antiretroviral therapy: drug effect or liver disease severity? |
topic | Hepatology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780040/ https://www.ncbi.nlm.nih.gov/pubmed/26966552 http://dx.doi.org/10.1136/bmjgast-2015-000072 |
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