Hernandez L V, Gilson I, Jacobson J, Affi A, Puetz T R, Dindzans V J
Division of Gastroenterology, Section of Liver Diseases, University of Wisconsin Medical School, 945 N. 12th Street, Milwaukee, WI 53233, USA.
Aliment Pharmacol Ther. 2001 Oct;15(10):1627-32. doi: 10.1046/j.1365-2036.2001.01086.x.
Drug hepatotoxicity is a potentially serious adverse reaction of antiretroviral therapy in human immunodeficiency virus-infected patients. The impact of this problem in the routine treatment of patients with human immunodeficiency virus infection is poorly defined.
Our aim was to determine what clinical features are associated with hepatotoxicity in human immunodeficiency virus-infected patients receiving antiretroviral therapy.
Consecutive patients in a primary care-based human immunodeficiency virus clinic were evaluated for hepatotoxicity. Clinic records were used to obtain patient characteristics, as well as independent variables including CD4+ count, coexisting hepatitis C and current alcohol use.
Sixty-five patients taking antiretroviral therapy were evaluated. Twenty-four were identified to have antiretroviral hepatotoxicity. An age over 40 years (P=0.019), an absolute CD4+ count of less than 310 cells/mL (P=0.002) and coexisting hepatitis C infection (P=0.035) were significantly associated with hepatotoxicity. Patients older than 40 years had a sevenfold increased risk (risk ratio, 6.9; 95% confidence interval, 1.7-27.3) and those with an absolute CD4+ count of less than 310 cells/mL had a tenfold increased risk (risk ratio, 10.2; 95% confidence interval, 2.5-41.9) for antiretroviral hepatotoxicity, in comparison with those who were younger or who had a greater absolute CD4+ count. Of the eight patients documented to have coexisting hepatitis C infection, six (75%) were in the antiretroviral hepatotoxicity group.
An age older than 40 years and an absolute CD4+ count of less than 310 cells/mL were significantly associated with antiretroviral-induced hepatotoxicity. The majority of our patients with chronic hepatitis C had hepatotoxicity from antiretroviral therapy.
药物性肝毒性是人类免疫缺陷病毒（HIV）感染患者接受抗逆转录病毒治疗时潜在的严重不良反应。该问题在HIV感染患者常规治疗中的影响尚不明确。
我们的目的是确定接受抗逆转录病毒治疗的HIV感染患者中与肝毒性相关的临床特征。
对一家以初级保健为基础的HIV诊所的连续患者进行肝毒性评估。利用诊所记录获取患者特征以及包括CD4+细胞计数、合并丙型肝炎和当前饮酒情况在内的独立变量。
对65例接受抗逆转录病毒治疗的患者进行了评估。其中24例被确定为具有抗逆转录病毒药物性肝毒性。年龄超过40岁（P = 0.019）、绝对CD4+细胞计数低于310个/毫升（P = 0.002）以及合并丙型肝炎感染（P = 0.035）与肝毒性显著相关。与年龄较小或绝对CD4+细胞计数较高的患者相比，年龄超过40岁的患者发生抗逆转录病毒药物性肝毒性的风险增加了7倍（风险比，6.9；95%置信区间，1.7 - 27.3），而绝对CD4+细胞计数低于310个/毫升的患者风险增加了10倍（风险比，10.2；95%置信区间，2.5 - 41.9）。在记录有合并丙型肝炎感染的8例患者中，6例（75%）在抗逆转录病毒药物性肝毒性组。
年龄超过40岁和绝对CD4+细胞计数低于310个/毫升与抗逆转录病毒药物引起的肝毒性显著相关。我们大多数合并慢性丙型肝炎的患者发生了抗逆转录病毒治疗所致的肝毒性。
