Question:
SIR, I WORK IN A PRISON WHERE MOST OF MY HIV/AIDS PATIENTS
ARE CO-INFECTED WITH HEP A, B, AND C. WHILE USING THE PROTEASE
INHIBITORS I HAVE NOTICED THAT THESE PATIENTS DO WELL FOR 3-6 MONTHS
THEN THEIR LIVER FUNCTION STUDIES START TO DETERIORATE. MY QUESTION IS
COULD THE HIV PROTEASE INHIBITORS HAVE AN EFFECT ON HEP C PROTEASE? OR
BECAUSE OF THE DAMAGE THAT HAS BEEN DONE TO THE LIVER BY THESE
INFECTIONS ARE THE HIV PROTEASE INHIBITORS JUST TO TOXIC? THANK YOU FOR
YOUR TIME.
Dr. Pavia's Response:
The exciting news in Hep C is that two groups have
crystallized the protease of Hep C - the first step in designing drugs to
attack it, which are desperately needed. To the best of my knowledge,
the protease of hep C is quite different from HIV and it is unlikely
that the HIV protease inhibitors will inhibit it. Some of the HIV
protease inhibitors cause abnormalities in liver function tests as part
of their toxicities, and this is most likely what is going on. These
toxicities may be worse in patients with chronic hepatitis B or C.
Ritonavir causes increases in ALT, AST, GGT and Alk phos in quite a few
patients. Indinavir usually causes an isolated increase in bilirubin
(sometimes causing mild jaundice) but doesn't seem to cause inflammation.
Low rates of transaminase elevations are also seen with nelfinavir, D4T,
ddI and less commonly with AZT and 3TC.
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