乌干达坎帕拉基于奈韦拉平的固定剂量复方抗逆转录病毒疗法期间的肝毒性
Hepatotoxicity during nevirapine-based fixed-dose combination antiretroviral therapy in kampala, Uganda.
作者信息
Hahn Judith A, Maier Marissa, Byakika-Tusiime Jayne, Oyugi Jessica H, Bangsberg David R
机构信息
Epidemiology and Preventions Center, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94143-1372, USA.
出版信息
J Int Assoc Physicians AIDS Care (Chic). 2007 Jun;6(2):83-6. doi: 10.1177/1545109707299356.
BACKGROUND
Generic, low-cost, nevirapine (NVP)-based antiretroviral therapy (ART) has improved survival in HIV-infected individuals living in resource-limited settings. However, there is concern about the potential hepatotoxicity of these regimens.
METHODS
The authors conducted a prospective study of persons initiating self-pay Triomune or Maxivir therapy in Kampala, Uganda.
RESULTS
The 97 study participants were predominantly women (64%), median age was 35 (interquartile range [IQR] 30-40), median CD4 at baseline was 56 cells/mm(3) (IQR 8-138), and 19% had lifetime alcohol problems (CAGE >/= 2). Severe liver enzyme elevations (LEEs) of grade 3-4 were rare (2.2%); however, 1 patient died in the setting of grade 4 LEEs. Grade 1-4 LEEs occurred among 22.2% of participants, and 9.8% had new grade 1-4 LEEs after the initiation of treatment.
DISCUSSION
The authors found that LEEs were common but that severe hepatotoxicity in persons initiating NVP-based ART was infrequent yet potentially life-threatening. Monitoring for NVP-related severe hepatic toxicity should be part of expanding antiretroviral treatment programs in resource-limited settings.
背景
以通用、低成本的奈韦拉平（NVP）为基础的抗逆转录病毒疗法（ART）提高了生活在资源有限环境中的HIV感染者的生存率。然而，人们担心这些治疗方案可能存在肝毒性。
方法
作者对乌干达坎帕拉开始自费使用三联疗法或玛西韦疗法的患者进行了一项前瞻性研究。
结果
97名研究参与者主要为女性（64%），中位年龄为35岁（四分位间距[IQR]为30 - 40），基线时CD4细胞计数中位数为56个细胞/mm³（IQR为8 - 138），19%的人有长期饮酒问题（CAGE评分≥2）。3 - 4级严重肝酶升高（LEEs）很少见（2.2%）；然而，1例患者在4级LEEs情况下死亡。1 - 4级LEEs发生在22.2%的参与者中，9.8%的人在开始治疗后出现新的1 - 4级LEEs。
讨论
作者发现LEEs很常见，但开始基于NVP的ART治疗的患者中严重肝毒性虽不常见但可能危及生命。在资源有限的环境中，对与NVP相关的严重肝毒性进行监测应成为扩大抗逆转录病毒治疗项目的一部分。
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