Acute liver injury rare in first year of ART

ART rarely led to severe acute liver injury within 1 year of treatment among patients with HIV, according to data from a retrospective cohort study.

Researchers noted, however, that protease inhibitor use was linked with a greater risk for aminotransferase elevations among patients who were coinfected with hepatitis.

“Current antiretrovirals, including the integrase strand transfer inhibitors and newer protease inhibitors, such as atazanavir and darunavir, are highly efficacious,” researchers, including Vincent Lo Re, III, MD, MSCE, assistant professor of medicine and epidemiology at the University of Pennsylvania’s Perelman School of Medicine. “However, antiretrovirals have been associated with acute liver injury, manifested by liver aminotransferase elevations or, in more serious cases, hepatic dysfunction and acute liver failure. Analyses that evaluate the antiretroviral-associated hepatotoxicity in clinical practice settings are important to ensure the safety of these medications among HIV–infected individuals, particularly those with viral hepatitis coinfection.”

The researchers followed two cohorts of patients with HIV: 2,099 from treated at Kaiser Permanente Northern California health care system from 2004 to 2010 and 7,984 patients from the Veterans Aging Cohort Study from 2004 to 2012. Lo Re and colleagues tracked the occurrence of liver aminotransferases greater than 200 U/L and severe acute liver injury.

Two hundred-six patients (2%) developed liver aminotransferases greater than 200 U/L, the researchers reported. This was more common in patients with HIV/viral hepatitis coinfection than in those who had only HIV (116.1 events vs. 20.7 events per 1,000 person years; P < .001). Lo Re and colleagues wrote that there was “no evidence of differential risk” between initiators of abacavir/lamivudine vs. tenofovir/emtricitabine in either patients with HIV (HR = 1.19; 95% CI, 0.47-2.97) or those with HIV/viral hepatitis coinfection (HR = 0.68; 95% CI, 0.29-1.57). Patients with coinfection had a higher risk for having aminotransferases greater than 200 U/L after initiating protease inhibitors compared with non-nucleoside reverse transcriptase inhibitors (HR = 2.01; 95% CI, 1.36-2.96).

Severe acute liver injury (30 events, 0.3%) was more common in patients with coinfection (15.9 events vs. 3.1 per 1,000 person-years; P < .001). However, the researchers wrote that liver injury was too rare to be evaluated with adjusted analysis.

“In summary, severe acute liver injury events were rare among HIV–infected persons initiating ART,” the researchers wrote. “Patients with viral hepatitis had higher rates of aminotransferase elevations and hepatic dysfunction than those with HIV alone.” – by Andy Polhamus

Disclosure: Lo Re reports a research grant from AstraZeneca. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.