Some HIV-Positive People at Greater Risk for Liver Problems

HIV-infected patients who are taking antiretroviral drugs can have a jump in liver enzymes in the blood -- a sign of possible liver damage. A new study in the July 1 edition of Journal of Infectious Diseases (2002;186:23-31) suggests that women may be at greater risk than men, as are those with liver-infecting viruses, such as hepatitis B or C.

Dr. Ferdinand Wit of the Academic Medical Center in Amsterdam and colleagues studied 560 patients who began taking antiretroviral drugs between July 1996 and January 2000. In roughly a three-year period after beginning the drugs, 8 percent of patients experienced liver enzyme levels more than ten times the upper limit of normal. However, none of the patients died from complications related to the problem, the authors noted.

Those with chronic hepatitis B or C infection were at greater risk, as were female patients. Those who had never received combination antiretroviral therapy before and patients who recently began a regimen containing nevirapine or high-dose ritonavir were also at risk. At least one risk factor was present in 97 percent of patients with severely elevated liver enzymes (hepatotoxicity).

In patients with hepatitis B, discontinuing the drug lamivudine also was a risk factor for severely elevated liver enzymes. Based on this, the authors suggest that even if lamivudine-resistant HIV strains develop in these patients, continued use of the drug should be considered.

While the incidence of severely elevated liver enzymes is rather high, most cases do not cause any symptoms and resolve without requiring a change in the drug regimen, the investigators noted. However, cases involving nevirapine require careful monitoring, they said. Nevirapine "has been linked to several fatal cases of hepatotoxicity," they emphasized.

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