Yu-Tzu Tseng1, Chia-Jui Yang2, Sui-Yuan Chang3, Shu-Wen Lin4, Mao-Song Tsai2, Wen-Chun Liu1, Pei-Ying Wu5, Yi-Ching Su1, Yu-Zhen Luo5, Shang-Ping Yang5, Chien-Ching Hung6, Shan-Chwen Chang1. 1. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 100, Taiwan. 2. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. 3. Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan. 4. Department of Pharmacy, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Pharmacy, National Taiwan University, Taipei, Taiwan. 5. Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 100, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan. Electronic address: hcc0401@ntu.edu.tw.
Abstract
OBJECTIVES: To retrospectively investigate the incidence of and factors associated with skin rashes and hepatotoxicity in HIV-infected patients who initiated combination antiretroviral therapy (cART) containing nevirapine plus two nucleos(t)ide reverse-transcriptase inhibitors. METHODS: The medical records of HIV-infected adult patients who started nevirapine-containing cART and continued follow-up for ≥4 weeks were reviewed at two hospitals in Taiwan between 2000 and 2012. Clinical data obtained at baseline and during follow-up were collected and analyzed. RESULTS: Of the 338 patients included in the analysis, 13.0% tested positive for hepatitis B virus surface antigen and 7.9% tested positive for anti-hepatitis C virus antibody. The incidence of rashes was 21.6% and of hepatotoxicity was 25.5%. On multiple logistic regression analysis, a two-fold or greater increase from the upper limit of normal levels of aminotransferases at baseline was associated with rashes (adjusted odds ratio (aOR) 3.74, 95% confidence interval (CI) 1.56-8.96); higher CD4 counts (aOR for per 50 cells/μl increase 1.51, 95% CI 1.12-2.03) and the concurrent use of trimethoprim/sulfamethoxazole (aOR 14.01, 95% CI 1.98-98.95) were associated with hepatotoxicity. CONCLUSIONS: Abnormal liver function at baseline was significantly associated with skin rashes, while a higher CD4 count and the concurrent use of trimethoprim/sulfamethoxazole were associated with hepatotoxicity after the initiation of nevirapine-containing cART in HIV-infected Taiwanese patients.
OBJECTIVES: To retrospectively investigate the incidence of and factors associated with skin rashes and hepatotoxicity in HIV-infectedpatients who initiated combination antiretroviral therapy (cART) containing nevirapine plus two nucleos(t)ide reverse-transcriptase inhibitors. METHODS: The medical records of HIV-infected adultpatients who started nevirapine-containing cART and continued follow-up for ≥4 weeks were reviewed at two hospitals in Taiwan between 2000 and 2012. Clinical data obtained at baseline and during follow-up were collected and analyzed. RESULTS: Of the 338 patients included in the analysis, 13.0% tested positive for hepatitis B virus surface antigen and 7.9% tested positive for anti-hepatitis C virus antibody. The incidence of rashes was 21.6% and of hepatotoxicity was 25.5%. On multiple logistic regression analysis, a two-fold or greater increase from the upper limit of normal levels of aminotransferases at baseline was associated with rashes (adjusted odds ratio (aOR) 3.74, 95% confidence interval (CI) 1.56-8.96); higher CD4 counts (aOR for per 50 cells/μl increase 1.51, 95% CI 1.12-2.03) and the concurrent use of trimethoprim/sulfamethoxazole (aOR 14.01, 95% CI 1.98-98.95) were associated with hepatotoxicity. CONCLUSIONS:Abnormal liver function at baseline was significantly associated with skin rashes, while a higher CD4 count and the concurrent use of trimethoprim/sulfamethoxazole were associated with hepatotoxicity after the initiation of nevirapine-containing cART in HIV-infected Taiwanese patients.
Authors: David S Goldberg; Kimberly A Forde; Dena M Carbonari; James D Lewis; Kimberly B F Leidl; K Rajender Reddy; Kevin Haynes; Jason Roy; Daohang Sha; Amy R Marks; Jennifer L Schneider; Brian L Strom; Douglas A Corley; Vincent Lo Re Journal: Gastroenterology Date: 2015-02-28 Impact factor: 22.682