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Nevirapine may increase liver fibrosis in HIV/HCV co-infected patients
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Effect of antiretroviral drugs on liver fibrosis in HIV-infected patients with chronichepatitis C: harmful impact of nevirapine
NEW YORK (Reuters Health) - Liver fibrosis appears to progress more rapidly in patients infected with both HIV and hepatitis C (HCV) who are treated with nevirapine, Spanish researchers report. On the other hand, protease inhibitors may be protective in this patient population.
Dr. Juan A. Pineda, at Hospital Universitario de Valme in Seville, and colleagues conducted a cross-sectional study to examine the relationship between antiretroviral drugs and liver fibrosis.
Specifically, they evaluated liver biopsy data obtained from 152 patients co-infected with HIV and HCV and considered to be compliant with therapy. According to their report in the March 26th issue of AIDS, 25 had been treated with nevirapine-based regimens, 20 with efavirenz-containing regimens, and 78 with a protease inhibitor-based therapy prior to biopsy.
Median estimated duration of HCV infection was 13 years and median fibrosis rate (ratio between fibrosis stage and estimated duration of HCV infection) was 0.143. Rates greater than 0.2, corresponding to at least 1 fibrosis stage after 5 years, were considered to be clinically meaningful.
Odds ratios were adjusted for variables associated with liver fibrosis, including age, duration of infection, gender, alcohol intake, viremia and CD4 cell counts.
Patients exposed to nevirapine were more likely to have stage 3 or 4 fibrosis (adjusted odds ratio 2.56, p = 0.04) and to have progression rates > 0.2 (adjusted OR 3.82, p < 0.001).
Fibrosis stage and progression rate were significantly lower for those exposed to a protease inhibitor (adjusted ORs 0.39 for both).
The risk of progressive fibrosis tended to be lower for efavirenz-based therapy, although the trends did not reach statistical significance, indicating that "the effect of nevirapine is not related to the NNRTI drug class, but rather to individual characteristics of this drug."
It may be that protease inhibitor-based HAART "could be more advantageous in terms of liver fibrosis progression than nevirapine-based regimens," Dr. Pineda and his associates suggest, but the association needs to be confirmed using hard end-points, such as decompensated cirrhosis or death due to liver failure.
AIDS 2004;18:767-774.

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