Association between Exposure to Nevirapine and Reduced Liver Fibrosis Progression in Patients with HIV and Hepatitis C Virus Coinfection

• Published in: Clinical infectious diseases 2008-01, Vol.46 (1), p.137-143
• Main Authors: Berenguer, Juan, Bellón, José M., Miralles, Pilar, Álvarez, Emilio, Castillo, Isabel, Cosín, Jaime, López, Juan Carlos, Sánchez Conde, Matilde, Padilla, Belén, Resino, Salvador
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretrovirals; Antivirals; Benzoxazines - therapeutic use; Biological and medical sciences; Biopsies; Coinfection; Correlation analysis; Cross-Sectional Studies; Disease Progression; Drug therapy; Female; Fibrosis; Gastroenterology. Liver. Pancreas. Abdomen; Hepacivirus; Hepatitis; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - pathology; Hepatitis C - virology; Hepatitis C virus; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - pathology; HIV Infections - virology; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Interferon-alpha - therapeutic use; Liver; Liver Cirrhosis - drug therapy; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Nevirapine - therapeutic use; Other diseases. Semiology; Protease inhibitors; Protease Inhibitors - therapeutic use; Retrospective Studies; Reverse Transcriptase Inhibitors - therapeutic use; Ribavirin - therapeutic use; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral hepatitis; Viral Load
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/524080

Background. We analyzed the effect of exposure to nonnucleoside reverse‐transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) on the progression of liver fibrosis in patients with human immunodeficiency virus (HIV) and hepatitis C virus coinfection. Methods. We analyzed data and liver biopsy findings for 201 coinfected patients. Fibrosis was scored following the French METAVIR Cooperative Study Group. We used multinomial logistic regression analysis and the fibrosis progression rate to assess the association between cumulative exposure to antiretroviral drugs and stage of fibrosis. Results. The adjusted odds ratio (AOR) and 95% confidence interval (CI) of having a fibrosis stage score of 0 or 1, compared with 3 or 4, increased with each additional year of exposure to HAART (AOR, 1.32; 95% CI, 1.04–1,67), to NNRTIs as a class (AOR, 1.64; 95% CI, 1.18–2.27), to efavirenz (AOR, 1.54; 95% CI, 1.03–2.30), and to nevirapine (AOR, 1.72; 95% CI, 1.15–2.78). This effect was not found with PIs as a class. The AOR (95% CI) of having a fibrosis stage score of 2 versus 3 or 4 increased with each additional year of exposure to NNRTIs (AOR, 1.51; 95% CI, 1.08–2.10) and nevirapine (AOR, 1.58; 95% CI, 1.06–2.37). This effect was not found with highly active antiretroviral therapy, PIs, or efavirenz. The AOR (95% CI) of having a fibrosis progression rate ⩽0.1 versus >0.1 increased with each additional year of exposure to highly active antiretroviral therapy (AOR, 1.31; 95% CI, 1.07–1.60), to NNRTIs (AOR, 1.33; 95% CI, 1.03–1.70), and to nevirapine (AOR, 1.44; 95% CI, 1.07–1.95). This effect was not found with PIs or with efavirenz. Conclusions. In contrast with previous studies, we found that exposure to NNRTIs was clearly associated with a reduction in fibrosis progression, whereas exposure to PIs was not. Of note, exposure to nevirapine was more consistently associated with a reduction in fibrosis progression than was exposure to efavirenz. Prospective work is needed in this area.