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Kaspar MB, Sterling RK. Hyperbilirubinaemia in HIV-HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?. BMJ Open Gastroenterol. 2016;3(1):e000072doi: 10.1136/bmjgast-2015-000072.
Kaspar, M. B., & Sterling, R. K. (2016). Hyperbilirubinaemia in HIV-HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?. BMJ open gastroenterology, 3(1), e000072. https://doi.org/10.1136/bmjgast-2015-000072
Kaspar, Matthew B, and Sterling, Richard K. "Hyperbilirubinaemia in HIV-HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?." BMJ open gastroenterology vol. 3,1 (2016): e000072. doi: https://doi.org/10.1136/bmjgast-2015-000072
Kaspar MB, Sterling RK. Hyperbilirubinaemia in HIV-HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?. BMJ Open Gastroenterol. 2016 Mar 02;3(1):e000072. doi: 10.1136/bmjgast-2015-000072. eCollection 2016. PMID: 26966552; PMCID: PMC4780040.
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BMJ Open Gastroenterol. 2016 Mar 02;3(1):e000072. doi: 10.1136/bmjgast-2015-000072. eCollection 2016.

Hyperbilirubinaemia in HIV-HCV co-infected patients on antiretroviral therapy: drug effect or liver disease severity?.

BMJ open gastroenterology

Matthew B Kaspar, Richard K Sterling

Affiliations

  1. Department of Internal Medicine , Virginia Commonwealth University Medical Center , Richmond, Virginia , USA.
  2. Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA; Section of Hepatology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA; Division of Infectious Disease, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.

PMID: 26966552 PMCID: PMC4780040 DOI: 10.1136/bmjgast-2015-000072

Abstract

OBJECTIVE: Hyperbilirubinaemia (HB) is common in HIV and hepatitis C virus (HIV-HCV) co-infected patients and poses a unique challenge in management as it may be due to medications such as the protease inhibitors (PIs) or to hepatic dysfunction. There are no data on the relationship of HB to liver histology and PI use in this population. Clinicians caring for these patients are faced with the difficult task of determining whether increasing serum bilirubin is due to drug effects or progression of liver disease.

METHODS: To address this gap in knowledge, we performed a retrospective analysis of 344 consecutive HIV-HCV co-infected patients undergoing liver biopsy to identify factors associated with HB. Demographic, clinical, laboratory data were collected. Advanced fibrosis was defined as bridging fibrosis or cirrhosis. Those with hepatitis B virus, hepatic decompensation or hepatocellular carcinoma were excluded.

RESULTS: The prevalence of HB (range 1.3-9.4) was 33% and more common in those on a PI (46%) than those who were not (10%; p≤0.001) and mostly in those on indinavir (40%) or atazanavir (46%). Of the patients on these PIs, HB was not associated with fibrosis grade, demographics, or other clinical variables. Conversely, in those not on a PI, HB was associated with fibrosis grade (p≤0.0001) after adjusting for other clinical and demographic variables.

CONCLUSIONS: In the setting of indinavir or atazanavir use, HB is common and unrelated to underlying disease severity and the medications can be continued safely. Conversely, HB in HIV-HCV co-infected patients not on a PI is due to their underlying liver disease and suggests these patients require closer monitoring.

Keywords: DRUG INDUCED HEPATOTOXICITY; HEPATITIS C; HIV-RELATED GASTROINTESTINAL DISEASE

References

  1. Dig Dis. 2014;32(6):791-9 - PubMed
  2. Enferm Infecc Microbiol Clin. 2008 Dec;26 Suppl 17:45-8 - PubMed
  3. J Hepatol. 2015 Feb;62(2):317-24 - PubMed
  4. Clin Infect Dis. 2001 Feb 1;32(3):492-7 - PubMed
  5. Clin Infect Dis. 2002 Mar 15;34(6):831-7 - PubMed
  6. Hepatology. 2005 Jun;41(6):1313-21 - PubMed
  7. N Engl J Med. 1998 Mar 26;338(13):853-60 - PubMed
  8. Hepatology. 2006 Jun;43(6):1317-25 - PubMed
  9. Ann Intern Med. 2003 Feb 4;138(3):197-207 - PubMed
  10. Hepatology. 2003 Aug;38(2):518-26 - PubMed
  11. Hepatology. 1981 Sep-Oct;1(5):431-5 - PubMed
  12. N Engl J Med. 2001 Feb 15;344(7):495-500 - PubMed
  13. AIDS Patient Care STDS. 2014 Oct;28(10):517-23 - PubMed
  14. Gastroenterology. 2013 Apr;144(4):751-760.e2 - PubMed
  15. J Hepatol. 2008 Feb;48(2):353-67 - PubMed
  16. Oncology. 2014;87 Suppl 1:63-72 - PubMed
  17. Clin Infect Dis. 2004 Mar 1;38 Suppl 2:S90-7 - PubMed
  18. Lancet. 2003 Nov 22;362(9397):1708-13 - PubMed
  19. J Acquir Immune Defic Syndr. 2010 Mar;53(3):323-32 - PubMed
  20. AIDS. 2004 Nov 19;18(17):2277-84 - PubMed
  21. AIDS. 2008 Nov 30;22(18):2535-7 - PubMed
  22. Drugs. 2003;63(16):1679-93; discussion 1694-5 - PubMed
  23. Antimicrob Agents Chemother. 2006 Feb;50(2):762-4 - PubMed
  24. Proc Natl Acad Sci U S A. 2001 Oct 23;98(22):12671-6 - PubMed

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