Print this page    •   Back to Web version of article

The Body Covers: The 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment

Adverse Event Risk on Abacavir + Lamivudine Is Not Higher for Patients Coinfected With Hepatitis B and/or Hepatitis C

Coverage provided by Mark Wainberg, Ph.D.

July 26, 2005

How safe are antiretroviral nucleosides in HIV-infected individuals who are coinfected with hepatitis B or hepatitis C? The question is an important one, because of two reasons: Firstly, up to one third of people with HIV are coinfected with hepatitis B or C. Secondly, there have been concerns that individuals who are coinfected with hepatitis B or hepatitis C may be at greater risk for nucleoside-mediated toxicities. This is particularly an issue due to the continued widespread use of abacavir (ABC, Ziagen) and lamivudine (3TC, Epivir) in the treatment of coinfected patients. Lamivudine is among the anti-HIV nucleosides that are known to possess potent anti-hepatitis B properties.

In this study, conducted by Henry Zhao et al from GlaxoSmithKline and presented by Trevor Scott, researchers looked at the safety in coinfected individuals of the fixed-dose combination drug abacavir/lamivudine (ABC/3TC, Combivir) in the context of 4 large, randomized clinical trials. Each trial had been conducted with HIV treatment-naive patients; abacavir/lamivudine was employed in combination with efavirenz (EFV, Sustiva, Stocrin) or any of a variety of protease inhibitors on a once-daily or twice-daily basis. The trials lasted a protracted period of time, i.e., greater than 48 weeks.

Of a total of 1,985 patients evaluated in the 4 trials, approximately 20% had been coinfected with hepatitis B and/or hepatitis C. The baseline characteristics and demographics of patients in both the non-coinfected and coinfected categories were similar, with the exception of baseline alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values, which were understandably much higher among coinfected patients.

The most important result of this analysis is that no differences were observed between the 2 groups in the overall incidence of adverse events, nor were differences observed in the type or incidence of specific adverse events. This similarity persisted regardless of whether patients received abacavir or lamivudine on a once-daily or twice-daily basis. Particularly reassuring was the finding that coinfected individuals did not demonstrate higher rates of abacavir-related hypersensitivity reactions than individuals infected only with HIV.

In conclusion, this study provides reassurance to clinicians and patients as to the relative safety of abacavir and lamivudine for use in coinfected individuals. Unfortunately, this study did not provide additional information on whether doubly coinfected individuals (patients with both hepatitis B and hepatitis C) may have developed greater rates of resistance to lamivudine in regard to mutations in the YMDD motif of the hepatitis B virus polymerase.

Copyright Body Health Resources Corporation. All rights reserved.

You can find this article online by typing the following address into your Web browser:

Please Note: Knowledge about HIV changes rapidly. Note the date of this article's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this article.

General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your healthcare provider.