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Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease inhibitors in a cohort of HIV/hepatitis C virus co-infected patients

Objectives To compare the frequency of grade 3 or 4 transaminase elevations (TEs) in HIV/hepatitis C virus (HCV) co-infected patients who started a three-antiretroviral drug regimen including efavirenz or a ritonavir-boosted protease inhibitor (PI/r) and the influence of pre-existing significant hep...

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Published in:Journal of antimicrobial chemotherapy 2011-11, Vol.66 (11), p.2605-2614
Main Authors: Neukam, Karin, Mira, José A., Ruiz-Morales, Josefa, Rivero, Antonio, Collado, Antonio, Torres-Cornejo, Almudena, Merino, Dolores, de los Santos-Gil, Ignacio, Macías, Juan, González-Serrano, Mercedes, Camacho, Angela, Parra-García, Ginés, Pineda, Juan A.
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cited_by cdi_FETCH-LOGICAL-c441t-3939d5fdee63cc52cd51f3875cfc1d4a1ec6e9c13aa12d63c0fcaa260f357bc33
cites cdi_FETCH-LOGICAL-c441t-3939d5fdee63cc52cd51f3875cfc1d4a1ec6e9c13aa12d63c0fcaa260f357bc33
container_end_page 2614
container_issue 11
container_start_page 2605
container_title Journal of antimicrobial chemotherapy
container_volume 66
creator Neukam, Karin
Mira, José A.
Ruiz-Morales, Josefa
Rivero, Antonio
Collado, Antonio
Torres-Cornejo, Almudena
Merino, Dolores
de los Santos-Gil, Ignacio
Macías, Juan
González-Serrano, Mercedes
Camacho, Angela
Parra-García, Ginés
Pineda, Juan A.
description Objectives To compare the frequency of grade 3 or 4 transaminase elevations (TEs) in HIV/hepatitis C virus (HCV) co-infected patients who started a three-antiretroviral drug regimen including efavirenz or a ritonavir-boosted protease inhibitor (PI/r) and the influence of pre-existing significant hepatic fibrosis or cirrhosis. Patients and methods All pre-treated or treatment-naive HIV/HCV co-infected patients who started an antiretroviral regimen including two nucleos(t)ide reverse transcriptase inhibitors along with efavirenz or a PI/r in seven Spanish centres from January 2007 to December 2009 were included in this prospective study. Results Of 262 patients included in this study, 76 (29%) individuals began antiretroviral therapy (ART) including efavirenz and 186 (71%) a PI/r-based combination. The median (interquartile) follow-up was 14.0 (6.2-23.7) months. A total of 20 (7.6%) patients presented grade 3-4 TEs. Four (1.5%) subjects discontinued ART due to this adverse event. Grade 3-4 TEs were observed in 5 (6.6%) subjects receiving efavirenz and 15 (8.1%) treated with PI/r (P = 0.681). Three (6.5%) patients in the efavirenz group with significant fibrosis developed grade 3-4 TEs versus 2 (8.7%) without pre-existing significant fibrosis (P = 0.743). In the PI/r group, the corresponding figures were 10 (8.8%) and 5 (9.3%), respectively (P = 0.931). Conclusions The frequency of grade 3-4 TEs associated with efavirenz-based ART combinations under clinical practice conditions is low and similar to that found in patients receiving PI/r currently used in HIV/HCV co-infected patients. The baseline fibrosis stage does not have an impact on the development of TEs caused by these antiretroviral drugs in this population.
doi_str_mv 10.1093/jac/dkr357
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Patients and methods All pre-treated or treatment-naive HIV/HCV co-infected patients who started an antiretroviral regimen including two nucleos(t)ide reverse transcriptase inhibitors along with efavirenz or a PI/r in seven Spanish centres from January 2007 to December 2009 were included in this prospective study. Results Of 262 patients included in this study, 76 (29%) individuals began antiretroviral therapy (ART) including efavirenz and 186 (71%) a PI/r-based combination. The median (interquartile) follow-up was 14.0 (6.2-23.7) months. A total of 20 (7.6%) patients presented grade 3-4 TEs. Four (1.5%) subjects discontinued ART due to this adverse event. Grade 3-4 TEs were observed in 5 (6.6%) subjects receiving efavirenz and 15 (8.1%) treated with PI/r (P = 0.681). Three (6.5%) patients in the efavirenz group with significant fibrosis developed grade 3-4 TEs versus 2 (8.7%) without pre-existing significant fibrosis (P = 0.743). In the PI/r group, the corresponding figures were 10 (8.8%) and 5 (9.3%), respectively (P = 0.931). Conclusions The frequency of grade 3-4 TEs associated with efavirenz-based ART combinations under clinical practice conditions is low and similar to that found in patients receiving PI/r currently used in HIV/HCV co-infected patients. The baseline fibrosis stage does not have an impact on the development of TEs caused by these antiretroviral drugs in this population.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkr357</identifier><identifier>PMID: 21903660</identifier><identifier>CODEN: JACHDX</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Anti-HIV Agents - administration &amp; dosage ; Anti-HIV Agents - adverse effects ; Anti-HIV Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral drugs ; Benzoxazines - administration &amp; dosage ; Benzoxazines - adverse effects ; Benzoxazines - therapeutic use ; Biological and medical sciences ; CD4 Lymphocyte Count ; Clinical trial. Drug monitoring ; Cohort Studies ; Coinfection ; Drug therapy ; Drug Therapy, Combination ; Drug toxicity and drugs side effects treatment ; Female ; General pharmacology ; Hepacivirus - drug effects ; Hepatitis ; Hepatitis C ; Hepatitis C - complications ; Hepatitis C - drug therapy ; Hepatitis C virus ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Protease Inhibitors - administration &amp; dosage ; HIV Protease Inhibitors - adverse effects ; HIV Protease Inhibitors - therapeutic use ; HIV-1 - drug effects ; Human immunodeficiency virus ; Humans ; Liver - drug effects ; Liver - enzymology ; Liver - pathology ; Liver - virology ; Liver Cirrhosis - complications ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Ritonavir - administration &amp; dosage ; Ritonavir - adverse effects ; Ritonavir - therapeutic use ; Toxicity ; Toxicity: digestive system ; Transaminases - blood</subject><ispartof>Journal of antimicrobial chemotherapy, 2011-11, Vol.66 (11), p.2605-2614</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Oxford Publishing Limited(England) Nov 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-3939d5fdee63cc52cd51f3875cfc1d4a1ec6e9c13aa12d63c0fcaa260f357bc33</citedby><cites>FETCH-LOGICAL-c441t-3939d5fdee63cc52cd51f3875cfc1d4a1ec6e9c13aa12d63c0fcaa260f357bc33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=24628778$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21903660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neukam, Karin</creatorcontrib><creatorcontrib>Mira, José A.</creatorcontrib><creatorcontrib>Ruiz-Morales, Josefa</creatorcontrib><creatorcontrib>Rivero, Antonio</creatorcontrib><creatorcontrib>Collado, Antonio</creatorcontrib><creatorcontrib>Torres-Cornejo, Almudena</creatorcontrib><creatorcontrib>Merino, Dolores</creatorcontrib><creatorcontrib>de los Santos-Gil, Ignacio</creatorcontrib><creatorcontrib>Macías, Juan</creatorcontrib><creatorcontrib>González-Serrano, Mercedes</creatorcontrib><creatorcontrib>Camacho, Angela</creatorcontrib><creatorcontrib>Parra-García, Ginés</creatorcontrib><creatorcontrib>Pineda, Juan A.</creatorcontrib><creatorcontrib>SEGURIDAD HEPÁTICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</creatorcontrib><creatorcontrib>on behalf of the SEGURIDAD HEPATICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</creatorcontrib><title>Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease inhibitors in a cohort of HIV/hepatitis C virus co-infected patients</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Objectives To compare the frequency of grade 3 or 4 transaminase elevations (TEs) in HIV/hepatitis C virus (HCV) co-infected patients who started a three-antiretroviral drug regimen including efavirenz or a ritonavir-boosted protease inhibitor (PI/r) and the influence of pre-existing significant hepatic fibrosis or cirrhosis. Patients and methods All pre-treated or treatment-naive HIV/HCV co-infected patients who started an antiretroviral regimen including two nucleos(t)ide reverse transcriptase inhibitors along with efavirenz or a PI/r in seven Spanish centres from January 2007 to December 2009 were included in this prospective study. Results Of 262 patients included in this study, 76 (29%) individuals began antiretroviral therapy (ART) including efavirenz and 186 (71%) a PI/r-based combination. The median (interquartile) follow-up was 14.0 (6.2-23.7) months. A total of 20 (7.6%) patients presented grade 3-4 TEs. Four (1.5%) subjects discontinued ART due to this adverse event. Grade 3-4 TEs were observed in 5 (6.6%) subjects receiving efavirenz and 15 (8.1%) treated with PI/r (P = 0.681). Three (6.5%) patients in the efavirenz group with significant fibrosis developed grade 3-4 TEs versus 2 (8.7%) without pre-existing significant fibrosis (P = 0.743). In the PI/r group, the corresponding figures were 10 (8.8%) and 5 (9.3%), respectively (P = 0.931). Conclusions The frequency of grade 3-4 TEs associated with efavirenz-based ART combinations under clinical practice conditions is low and similar to that found in patients receiving PI/r currently used in HIV/HCV co-infected patients. The baseline fibrosis stage does not have an impact on the development of TEs caused by these antiretroviral drugs in this population.</description><subject>Adult</subject><subject>Anti-HIV Agents - administration &amp; dosage</subject><subject>Anti-HIV Agents - adverse effects</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral drugs</subject><subject>Benzoxazines - administration &amp; dosage</subject><subject>Benzoxazines - adverse effects</subject><subject>Benzoxazines - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>CD4 Lymphocyte Count</subject><subject>Clinical trial. Drug monitoring</subject><subject>Cohort Studies</subject><subject>Coinfection</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Drug toxicity and drugs side effects treatment</subject><subject>Female</subject><subject>General pharmacology</subject><subject>Hepacivirus - drug effects</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Hepatitis C - complications</subject><subject>Hepatitis C - drug therapy</subject><subject>Hepatitis C virus</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Protease Inhibitors - administration &amp; dosage</subject><subject>HIV Protease Inhibitors - adverse effects</subject><subject>HIV Protease Inhibitors - therapeutic use</subject><subject>HIV-1 - drug effects</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Liver - drug effects</subject><subject>Liver - enzymology</subject><subject>Liver - pathology</subject><subject>Liver - virology</subject><subject>Liver Cirrhosis - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Ritonavir - administration &amp; dosage</subject><subject>Ritonavir - adverse effects</subject><subject>Ritonavir - therapeutic use</subject><subject>Toxicity</subject><subject>Toxicity: digestive system</subject><subject>Transaminases - blood</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp9kcGKFDEQhoMo7rh68QEkCCII7SSdTrpzXAZ1Fwa8qNemJl2xM_YkY5JeHZ_JhzTjjC548FQp_q_-FPUT8pSz15xpsdyCWQ5fopDtPbLgjWJVzTS_TxZMMFm1jRQX5FFKW8aYkqp7SC5qrplQii3Iz7W7xUhz-O6MywcKKQXjIONAv7k8UvDZRcwx3LoIE80jRtgfqPNmmgfnP1O0UCT0P2iINLoc_LGvNiGko8k-hoyQsEyMblPkmMqTAjVhDDHTYOn1zafliHvILrtEV7SMz6nolfMWzW-ToqHP6TF5YGFK-ORcL8nHt28-rK6r9ft3N6urdWWahudKaKEHaQdEJYyRtRkkt6JrpbGGDw1wNAq14QKA10NhmDUAtWK2nHBjhLgkL0--ZfuvM6bc71wyOE3gMcyp1zVrteRSFfL5P-Q2zNGX5Xpdzt11ba0L9OoEmRhSimj7fXQ7iIees_6YYF8S7E8JFvjZ2XHe7HD4i_6JrAAvzgAkA5ON4I1Ld1yj6q5tuzsuzPv_ffgLCOK2XQ</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Neukam, Karin</creator><creator>Mira, José A.</creator><creator>Ruiz-Morales, Josefa</creator><creator>Rivero, Antonio</creator><creator>Collado, Antonio</creator><creator>Torres-Cornejo, Almudena</creator><creator>Merino, Dolores</creator><creator>de los Santos-Gil, Ignacio</creator><creator>Macías, Juan</creator><creator>González-Serrano, Mercedes</creator><creator>Camacho, Angela</creator><creator>Parra-García, Ginés</creator><creator>Pineda, Juan A.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope></search><sort><creationdate>20111101</creationdate><title>Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease inhibitors in a cohort of HIV/hepatitis C virus co-infected patients</title><author>Neukam, Karin ; Mira, José A. ; Ruiz-Morales, Josefa ; Rivero, Antonio ; Collado, Antonio ; Torres-Cornejo, Almudena ; Merino, Dolores ; de los Santos-Gil, Ignacio ; Macías, Juan ; González-Serrano, Mercedes ; Camacho, Angela ; Parra-García, Ginés ; Pineda, Juan A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-3939d5fdee63cc52cd51f3875cfc1d4a1ec6e9c13aa12d63c0fcaa260f357bc33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Anti-HIV Agents - administration &amp; dosage</topic><topic>Anti-HIV Agents - adverse effects</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antibiotics. 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Drug treatments</topic><topic>Ritonavir - administration &amp; dosage</topic><topic>Ritonavir - adverse effects</topic><topic>Ritonavir - therapeutic use</topic><topic>Toxicity</topic><topic>Toxicity: digestive system</topic><topic>Transaminases - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neukam, Karin</creatorcontrib><creatorcontrib>Mira, José A.</creatorcontrib><creatorcontrib>Ruiz-Morales, Josefa</creatorcontrib><creatorcontrib>Rivero, Antonio</creatorcontrib><creatorcontrib>Collado, Antonio</creatorcontrib><creatorcontrib>Torres-Cornejo, Almudena</creatorcontrib><creatorcontrib>Merino, Dolores</creatorcontrib><creatorcontrib>de los Santos-Gil, Ignacio</creatorcontrib><creatorcontrib>Macías, Juan</creatorcontrib><creatorcontrib>González-Serrano, Mercedes</creatorcontrib><creatorcontrib>Camacho, Angela</creatorcontrib><creatorcontrib>Parra-García, Ginés</creatorcontrib><creatorcontrib>Pineda, Juan A.</creatorcontrib><creatorcontrib>SEGURIDAD HEPÁTICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</creatorcontrib><creatorcontrib>on behalf of the SEGURIDAD HEPATICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neukam, Karin</au><au>Mira, José A.</au><au>Ruiz-Morales, Josefa</au><au>Rivero, Antonio</au><au>Collado, Antonio</au><au>Torres-Cornejo, Almudena</au><au>Merino, Dolores</au><au>de los Santos-Gil, Ignacio</au><au>Macías, Juan</au><au>González-Serrano, Mercedes</au><au>Camacho, Angela</au><au>Parra-García, Ginés</au><au>Pineda, Juan A.</au><aucorp>SEGURIDAD HEPÁTICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</aucorp><aucorp>on behalf of the SEGURIDAD HEPATICA Study Team of the Grupo HEPAVIR de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease inhibitors in a cohort of HIV/hepatitis C virus co-infected patients</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>66</volume><issue>11</issue><spage>2605</spage><epage>2614</epage><pages>2605-2614</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><coden>JACHDX</coden><abstract>Objectives To compare the frequency of grade 3 or 4 transaminase elevations (TEs) in HIV/hepatitis C virus (HCV) co-infected patients who started a three-antiretroviral drug regimen including efavirenz or a ritonavir-boosted protease inhibitor (PI/r) and the influence of pre-existing significant hepatic fibrosis or cirrhosis. Patients and methods All pre-treated or treatment-naive HIV/HCV co-infected patients who started an antiretroviral regimen including two nucleos(t)ide reverse transcriptase inhibitors along with efavirenz or a PI/r in seven Spanish centres from January 2007 to December 2009 were included in this prospective study. Results Of 262 patients included in this study, 76 (29%) individuals began antiretroviral therapy (ART) including efavirenz and 186 (71%) a PI/r-based combination. The median (interquartile) follow-up was 14.0 (6.2-23.7) months. A total of 20 (7.6%) patients presented grade 3-4 TEs. Four (1.5%) subjects discontinued ART due to this adverse event. Grade 3-4 TEs were observed in 5 (6.6%) subjects receiving efavirenz and 15 (8.1%) treated with PI/r (P = 0.681). Three (6.5%) patients in the efavirenz group with significant fibrosis developed grade 3-4 TEs versus 2 (8.7%) without pre-existing significant fibrosis (P = 0.743). In the PI/r group, the corresponding figures were 10 (8.8%) and 5 (9.3%), respectively (P = 0.931). Conclusions The frequency of grade 3-4 TEs associated with efavirenz-based ART combinations under clinical practice conditions is low and similar to that found in patients receiving PI/r currently used in HIV/HCV co-infected patients. The baseline fibrosis stage does not have an impact on the development of TEs caused by these antiretroviral drugs in this population.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21903660</pmid><doi>10.1093/jac/dkr357</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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ispartof Journal of antimicrobial chemotherapy, 2011-11, Vol.66 (11), p.2605-2614
issn 0305-7453
1460-2091
language eng
recordid cdi_proquest_miscellaneous_920795156
source Oxford Journals Online
subjects Adult
Anti-HIV Agents - administration & dosage
Anti-HIV Agents - adverse effects
Anti-HIV Agents - therapeutic use
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiretroviral drugs
Benzoxazines - administration & dosage
Benzoxazines - adverse effects
Benzoxazines - therapeutic use
Biological and medical sciences
CD4 Lymphocyte Count
Clinical trial. Drug monitoring
Cohort Studies
Coinfection
Drug therapy
Drug Therapy, Combination
Drug toxicity and drugs side effects treatment
Female
General pharmacology
Hepacivirus - drug effects
Hepatitis
Hepatitis C
Hepatitis C - complications
Hepatitis C - drug therapy
Hepatitis C virus
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Protease Inhibitors - administration & dosage
HIV Protease Inhibitors - adverse effects
HIV Protease Inhibitors - therapeutic use
HIV-1 - drug effects
Human immunodeficiency virus
Humans
Liver - drug effects
Liver - enzymology
Liver - pathology
Liver - virology
Liver Cirrhosis - complications
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Ritonavir - administration & dosage
Ritonavir - adverse effects
Ritonavir - therapeutic use
Toxicity
Toxicity: digestive system
Transaminases - blood
title Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease inhibitors in a cohort of HIV/hepatitis C virus co-infected patients
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