UCLA

Hepatotoxicity is a common side effect of antiretroviral therapy with severe hepatotoxicity necessitating a regimen change. This was a retrospective cohort study that investigated the predictors of severe hepatotoxicity in a cohort of HIV-infected patients on antiretroviral therapy identified to have clinically significant elevations in transaminases. Severe hepatotoxicity was defined as an alanine aminotransferase level (ALT) greater than 275 IU/ml. The prevalence of severe hepatotoxicity was 23%. In multivariable stepwise regression analysis, only HBsAg, higher median HIV viral load and lower median ALT at database entry were predictors of severe hepatotoxicity. In a cohort of HIV and hepatitis B (HBV) coinfected patients, only higher log HIV viral load at database entry showed a trend towards significance as a predictor of severe hepatotoxicity, in multivariable stepwise regression analysis. Neither antiretroviral regimen class nor single agent was associated with severe hepatotoxicity. HBV infection, but not HCV infection, was a significant predictor of severe hepatotoxicity in HIV infected patients on antiretroviral therapy. Conclusion: In a cohort of HIV-infected patients receiving antiretroviral therapy, HBV infection, ALT and log HIV viral load at database entry were significant predictors of severe hepatotoxicity, while antiretroviral regimens were not.