Background: Drug hepatotoxicity is a potentially serious adverse reaction o
f antiretroviral therapy in human immunodeficiency virus-infected patients.
The impact of this problem in the routine treatment of patients with human
immunodeficiency virus infection is poorly defined.
Objectives: Our aim was to determine what clinical features are associated
with hepatotoxicity in human immunodeficiency virus-infected patients recei
ving antiretroviral therapy.
Methods: Consecutive patients in a primary care-based human immunodeficienc
y virus clinic were evaluated for hepatotoxicity. Clinic records were used
to obtain patient characteristics, as well as independent variables includi
ng CD4+ count, coexisting hepatitis C and current alcohol use.
Results: Sixty-five patients taking, antiretroviral therapy were evaluated.
Twenty-four were identified to have antiretroviral hepatotoxicity. An age
over 40 years (P=0.019), an absolute CD4+ count of less than 310 cells/mL (
P=0.002) and coexisting hepatitis C infection (P=0.035) were significantly
associated with hepatotoxicity. Patients older than 40 years had a sevenfol
d increased risk (risk ratio, 6.9; 95% confidence interval, 1.7-27.3) and t
hose with an absolute CD4+ count of less than 310 cells/mL had a tenfold in
creased risk (risk ratio, 10.2; 95% confidence interval, 2.5-41.9) for anti
retroviral hepatotoxicity, in comparison with those who were younger or who
had a greater absolute CD4+ count. Of the eight patients documented to hav
e coexisting hepatitis C infection, six (75%) were in the antiretroviral he
patotoxicity group.
Conclusions: An age older than 40 years and an absolute CD4+ count of less
than 310 cells/mL were significantly associated with antiretroviral-induced
hepatotoxicity. The majority of our patients with chronic hepatitis C had
hepatotoxicity from antiretroviral therapy.