A Smart + Strong Site
Subscribe to:
POZ magazine

Back to home » Treatment News » Top Stories

Most Popular Stories
Undetectable Viral Load Essentially Eliminates Transmission Risk in Straight Couples
FDA Approves New Single-Tablet HIV Regimen, Triumeq
Life Expectancy for Young People With HIV Is Nearly Normal
A 15-Year Jump in Life Expectancy for People With HIV
Scientists Devise Method of Snipping HIV From Immune Cells
Monkey HIV Vaccine Success Opens Door for Human Trials
HIV Combo Pill Less Toxic Thanks to New Form of Tenofovir
What's That Mean?
(just double-click it!)

If you don't understand one of the words in this article, just double-click it. A window will open with a definition from mondofacto's On-line Medical Dictionary. If the double-click feature doesn't work in your browser, you can enter the word below:

Most Popular Lessons
Aging & HIV
The HIV Life Cycle
Herpes Simplex Virus
Syphilis & Neurosyphilis
Treatments for Opportunistic Infections (OIs)
What is AIDS & HIV?
More News

Have medical or treatment news about HIV? Send press releases, news tips and other announcements to news@aidsmeds.com.

Click here for more news


March 16, 2012

ARV Liver Toxicity in HIV/Hep C Coinfected Patients on the Decline

by Tim Horn

CROI 2012 Rates of antiretroviral (ARV)-associated liver toxicity among people living with HIV and hepatitis C virus (HCV) have decreased since 1997, but it is still more common among people infected with both viruses compared with people infected only with HIV. This is the finding of an analysis reported Wednesday, March 7, at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle.

For people living with HIV, coinfection with HCV is known to increase the risk for, and rate of, liver toxicity from ARV therapy. Hepatotoxicity was a particular concern with commonly prescribed ARVs during the early years of combination HIV treatment, notably the late 1990s and early 2000s. In more recently years, the approval of newer agents has permitted health care providers to prescribe HIV combinations heralded as being safer than their predecessors, yet it hasn’t been clear whether evolved regimens have reduced the incidence of liver toxicity among people with HIV/HCV coinfection. 

To explore this question, Mark Hull, MD, from Canada’s BC Centre for Excellence in HIV/AIDS in Vancouver and his colleagues followed 748 people living with HIV—196 (26 percent) of whom were coinfected with HCV—over a span of 12 years. The study subjects were divided into three groups: those observed between January 1, 1997, until December 31, 1999 (period one); those observed between January 1, 2000, and December 31, 2003 (period two); and those observed between January 1, 2004, and December 31, 2009 (period three).

In this mostly male group averaging 42 years old, HIV treatment uptake increased over the years. During period one, 107 people (14 percent) started ARV treatment for HIV. In period two, 208 (28 percent) started ARV therapy. In period three, 433 (58 percent) began ARV treatment.

Liver toxicity was defined as an increase in alanine aminotransferase (ALT)—a liver enzyme that signals liver inflammation—using any of three criteria: Five times higher than pre-treatment levels, five times higher than the upper limit of normal or 3.5 to 5 times higher than pre-ARV therapy levels when pretreatment ALT was abnormally high. Liver enzyme levels were checked at 1,3, 6, 9 and 12 months after starting HIV treatment.

No matter which criteria were used to assess liver toxicity, it was much more likely among people living with HIV and HCV compared with those living with HIV alone. According to the researchers’ report, the average time to liver toxicity after starting ARV therapy was 10 months, when ALT levels increased from a pretreatment average of between 33 to 35 international units per liter (IU/L) to an on-treatment average of 508 to 515 IU/L.

During each time point, however, the estimated incidence rate of liver toxicity dropped.

During period one, the overall incidence of liver toxicity—among all people living with HIV on ARV therapy, irrespective of their HCV coinfection status—was roughly 17 per 100 person-years (PY). In other words, roughly 17 (17 percent) of 100 people included in the analysis who started HIV treatment between January 1997 and December 1999 and remained on ARV therapy for one year (or 34 percent of 50 people who started and remained on treatment for a two-year period) were estimated to have experienced liver toxicity.

Looking specifically at those with HIV/HCV coinfection starting ARV treatment during period one, the estimated incidence of liver toxicity was 37 per 100 PY. As for those with HIV but not HCV infection, the estimated incidence was roughly four per 100 PY.  

During period two, the overall incidence of liver toxicity decreased to approximately 10 per 100 PY. Among people coinfected with HIV and HCV, the estimated incidence of liver toxicity dropped to 30 per 100 PY, versus roughly one per 100 PY among those living with HIV alone.

During period three, the overall estimated incidence of liver toxicity dropped further, to nearly seven per 100 PY. Among people coinfected with HIV and HCV, the estimated incidence decreased to roughly 24 per 100 PY, compared with approximately two per 100 PY among those infected only with HIV.

“The overall incidence rate of hepatotoxicity after [ARV therapy] initiation has diminished in the modern era, but remains significantly higher in those with underlying HCV infection,” Hull and his colleagues remarked. “Coinfected patients should be assessed for consideration of HCV therapy prior to [ARV therapy] as a means of decreasing subsequent [ARV] -related hepatotoxicity,” they added, alluding to data from other studies showing that HCV treatment, when successful, lowers the risk for and rate of liver toxicity from HIV treatment.

Search: hiv, hcv, hepatitis c, coinfection, liver toxicity, hepatotoxicity, decline, hull, croi, seattle

Scroll down to comment on this story.


(will display; 2-50 characters)


(will NOT display)


(will display; optional)

Comment (500 characters left):

(Note: The AIDSmeds team reviews all comments before they are posted. Please do not include ":" "@" "<" ">" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)

Comments require captcha.
Please enter this number for verification:

| Posting Rules

Show comments (1 total)

[Go to top]

Quick Links
About HIV and AIDS
The Cure
Lab Tests
Clinical Trials
HIV Meds
Starting Treatment
Switching Treatment
Drug Resistance
Side Effects
Hepatitis & HIV
Women & Children
Fact Sheets
Treatment News
Community Forums
Conference Coverage
Health Services Directory
POZ Magazine
AIDSmeds on Twitter

Conference Coverage

XX International AIDS Conference
(AIDS 2014)
Melbourne, Australia
July 20 - 25, 2014

21st Conference on Retroviruses and Opportunistic Infections
(CROI 2014)
Boston, MA
March 3 - 7, 2014

7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention
(IAS 2013)
Kuala Lumpur, Malaysia
June 30 - July 3, 2013

more conference coverage

[ about AIDSmeds | AIDSmeds advisory board | our staff | advertising policy | advertise/contact us]
© 2016 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.