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Combination ART with Epzicom limits liver fibrosis progression
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Combination ART regimens built on a backbone of Epzicom may reduce the progression of liver fibrosis among patients with HIV/hepatitis C virus coinfection, according to recent data.
“The inclusion of dideoxynucleoside-containing backbones complicates the interpretation of the results of early studies, as these [nucleoside reverse transcriptase inhibitors (NRTIs)] are highly disruptive of mitochondrial function and are associated with steatosis,” the researchers wrote. “Currently, the recommended NRTI backbone combinations are [Truvada (tenofovir disoproxil fumarate/emtricitabine), Gilead Sciences; (TDF/FTC)] or [Epzicom (abacavir/lamivudine, ViiV Healthcare; (ABC/3TC)]. While these modern backbones have low levels of mitochondrial toxicity and are not generally considered hepatotoxic, there is limited information on their long-term impact on liver fibrosis.”
Using data from the Canadian Co-infection Cohort study, the researchers examined adult patients from 18 clinics with documented HIV infection and positive PCR results for HCV infection. Included patients were those who initiated either protease inhibitors (PI) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) combination ART with a TDF/FTC or ABC/3TC backbone. Liver fibrosis progression, as measured at each 6-month study visit by an aspartate-to-platelet ratio index (APRI), was compared among regimens. To reduce pre-existing imbalances between PI or NNRTI users, a propensity score matched sample was created for regression analysis.
From a pool of 348 patients, 314 were included in matching to create a sample equivalent to 628 persons. Seventy-one percent of these matched patients were treated with a PI-based regimen, 67% of whom received a backbone of TDF/FTC as opposed to a TDF/FTC rate of 69% among those treated with NNRTIs.
The researchers wrote that while overall median APRI scores were 32% higher among patients given a TDF/FTC backbone (95% CI, 14%-50%), changes in APRI score appeared to be driven by the use of ABC/3TC. Over the course of 5 years, ABC/3TC use with a PI increased median APRI score by 16% (95% CI, 4%-29%) and by 11% when used with an NNRTI (95% CI, 2%-20%). Conversely, no changes were seen over time among TDF/FTC users with either regimen, suggesting improved results from ABC/3TC regimens.
“The rate of change in APRI score seemed more influenced by the backbone than by the class of anchor agent in coinfected persons,” the researchers wrote. “Further investigation is required to better understand how different backbone/anchor drug combinations can affect the liver of HIV/HCV coinfected persons in the long-term.” – by Dave Muoio
Disclosure: Brunet reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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