Early changes in hepatic function among HIV–tuberculosis patients treated with nevirapine or efavirenz along with rifampin-based anti-tuberculosis therapy

Padmapriyadarsini, C. ; Bhavani, P. K. ; Tang, Alice ; Kumar, Hemanth ; Ponnuraja, C. ; Narendran, G. ; Hannah, Elizabeth ; Ramesh, C. ; Chandrasekar, C. ; Wanke, Christine ; Swaminathan, Soumya (2013) Early changes in hepatic function among HIV–tuberculosis patients treated with nevirapine or efavirenz along with rifampin-based anti-tuberculosis therapy International Journal of Infectious Diseases, 17 (12). e1154-e1159. ISSN 1201-9712

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Official URL: http://www.ijidonline.com/article/S1201-9712(13)00...

Related URL: http://dx.doi.org/10.1016/j.ijid.2013.08.006

Abstract

Objectives: To describe the longitudinal changes in hepatic function among HIV-infected tuberculosis (TB) patients receiving once-daily nevirapine (NVP)- or efavirenz (EFV)-based antiretroviral treatment (ART) along with rifampin-containing anti-TB treatment. Methods: This was a nested study within a randomized clinical trial, taking place between May 2006 and June 2008 at the National Institute for Research in Tuberculosis, Chennai, India. Antiretroviral-naïve HIV-infected TB patients were initiated on an intermittent short-course regimen and randomized to receive didanosine and lamivudine with either NVP (400 mg) or EFV (600 mg) once-daily. Blood was analyzed for alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum alkaline phosphatase (SAP), and bilirubin at baseline, at ART initiation, fortnightly after ART initiation until 2 months, then monthly until 6 months and 6-monthly thereafter. Results: Of the 168 patients included (79% men, median CD4 count 93 cells/mm3, median viral load 242 000 copies/ml), 104 were on EFV-based ART and 64 on NVP-based ART. There was a small but statistically significant elevation in ALT and SAP at 2 weeks and AST at 6 weeks after ART initiation. The proportion of patients with rate-limiting toxicity of liver enzymes was small. None had treatment terminated because of hepatotoxicity. Conclusion: Hepatotoxicity is not a major concern when HIV-infected TB patients, with normal baseline liver function initiate treatment for both infections simultaneously.

Item Type:Article
Source:Copyright of this article belongs to International Society for Infectious Diseases.
Keywords:Hepatic Function; HIV–TB Co-infection; ART; Nevirapine; Anti-tuberculosis Therapy
ID Code:110619
Deposited On:01 Sep 2017 09:26
Last Modified:01 Sep 2017 09:26

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