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Incidence and risk factors for liver enzyme elevation among naive HIV-1-infected patients receiving ART in the ICONA cohort

2019; Oxford University Press; Volume: 74; Issue: 11 Linguagem: Inglês

10.1093/jac/dkz353

1460-2091

Lucia Taramasso, P Lorenzini, Antonio Di Biagio, Miriam Lichtner, Giulia Marchetti, Roberto Rossotti, Giuseppe Lapadula, Alessandro Cozzi‐Lepri, Francesca Vichi, Andrea Antinori, Stefano Bonora, Antonella d’Arminio Monforte, Antonella d’Arminio Monforte, Andrea Antinori, Massimo Andreoni, Antonella Castagna, Francesco Castelli, Roberto Cauda, Giampaolo Perri, Massimo Galli, Rosaria Iardino, Giuseppe Ippolito, Adriano Lazzarin, Giulia Marchetti, G Rezza, F von Schloesser, Pierluigi Viale, Antonella d’Arminio Monforte, Andrea Antinori, Antonella Castagna, F Ceccherini-Silberstein, Alessandro Cozzi‐Lepri, Enrico Girardi, Sergio Lo Caputo, C Mussini, Massimo Puoti, Carlo Federico Perno, Andrea Antinori, Francesca Bai, Claudia Balotta, Alessandra Bandera, Stefano Bonora, Marco Borderi, Andrea Calcagno, Amedeo Capetti, Maria Rosaria Capobianchi, Antonella Castagna, F Ceccherini-Silberstein, S Cicalini, A. Cingolani, Paola Cinque, Alessandro Cozzi‐Lepri, Antonella d’Arminio Monforte, Andrea De Luca, Antonio Di Biagio, Enrico Girardi, Nicola Gianotti, Andrea Gori, Giovanni Guaraldi, Giuseppe Lapadula, Miriam Lichtner, Sergio Lo Caputo, Giordano Madeddu, F Maggiolo, Giulia Marchetti, Laura Monno, C Mussini, Silvia Nozza, Carlo Federico Perno, Carmela Pinnetti, Massimo Puoti, Eugenia Quirós-Roldán, Roberto Rossotti, Stefano Rusconi, Maria Mercedes Santoro, Annalisa Saracino, Loredana Sarmati, Alessandro Cozzi‐Lepri, Iuri Fanti, Laura Galli, P Lorenzini, A Rodano’, Marco Macchia, A Tavelli, Fabrizio Carletti, Silvia Carrara, Antonino Di, Silvia Graziano, F Petroni, Gennaro Prota, S Truffa, Andrea Giacometti, Andrea Costantini, V Barocci, Gioacchino Angarano, Laura Monno, Eugenio Milano, F Maggiolo, Claudia Suardi, Pierluigi Viale, Valentina Donati, Gabriella Verucchi, Filippo Castelnuovo, C Minardi, Eugenia Quirós-Roldán, Barbara Menzaghi, C Abeli, Bruno Cacopardo, Benedetto Maurizio Celesia, Jacopo Vecchiet, Katia Falasca, Angelo Pan, Silvia Lorenzotti, L Sighinolfi, Daniela Segala, P. Blanc, Francesca Vichi, Giovanni Cassola, Claudio Viscoli, A. Alessandrini, Nicoletta Bobbio, Giovanni Mazzarello, Miriam Lichtner, Serena Vita, P Bonfanti, Chiara Molteni, Alessandro Chiodera, P Milini, Giuseppe Nunnari, Giovanni Francesco Pellicanò, Antonella d’Arminio Monforte, Massimo Galli, Adriano Lazzarin, Gloria Montenegro Rizzardini, Massimo Puoti, Antonella Castagna, Elvira Stefania Cannizzo, M C Moioli, R. Piolini, Dario Bernacchia, Stefania Salpietro, Camilla Tincati, C Mussini, Cinzia Puzzolante, C Migliorino, Giuseppe Lapadula, Vincenzo Sangiovanni, Guglielmo Borgia, Vincenzo Esposito, Federica Martino, Ivan Gentile, Vincent Rizzo, Anna Maria Cattelan, Serena Marinello, Antonio Cascio, Marcello Trizzino, Franco Baldelli, Elisabetta Schiaroli, Giustino Parruti, F Sozio, G. Magnani, M A Ursitti, Massimo Andreoni, Andrea Antinori, Roberto Cauda, Antonio Cristaudo, Vincenzo Vullo, R Acinapura, Davide Moschese, M Capozzi, Annalisa Mondi, A. Cingolani, Marco Rivano Capparuccia, Giancarlo Iaiani, Alessandra Latini, Roberta Gagliardini, Maria Maddalena Plazzi, Stefano Savinelli, Alessandra Vergori, M Cecchetto, Franco Viviani, Giordano Madeddu, Andrea De Vito, Barbara Rossetti, Francesca Montagnani, Anaïs Franco‐Romero, Rosario Vecchio, Daniela Francisci, Giuliano Enzi, P Caramello, Giampaolo Perri, Stefano Bonora, Giancarlo Orofino, Mariangela Sciandra, Matteo Bassetti, Alejandra Londero, G. Pellizzer, Vinicio Manfrin, Giulio Starnini, A Ialungo,

Hepatitis C virus research

To evaluate the incidence and risk factors for liver enzyme elevations (LEE) in patients initiating first-line ART in the ICONA prospective observational cohort, between June 2009 and December 2017.In total, 6575 ART-naive patients were selected, initiating two NRTIs with the third drug being a boosted PI (n=2436; 37.0%), an NNRTI (n=2384; 36.3%) or an integrase strand transfer inhibitor (INSTI) (n=1755; 26.7%). HBV surface antigen and HCV RNA were detected in 3.9% and 5.8% of the study population. Inverse probability weighted Cox regression analysis was used to calculate the HRs, according to first-line regimen, for LEE, defined as ALT or AST increases of ≥2.5× upper limit of normal (ULN) for patients with normal baseline values or ≥2.5× baseline for patients with higher baseline values.One hundred and eighty-three LEE occurred over 20722 patient-years of follow-up. After adjusting for the main confounders, the risk of LEE halved with INSTIs compared with NNRTIs (HR 0.46, 95% CI 0.25-0.86), with a significant reduction in the raltegravir group (HR 0.11, 95% CI 0.02-0.84 using the NNRTI class as reference). HRs for LEE were significantly higher in subjects with HBV or HCV coinfection, in patients with poorly controlled HIV infection and in those who acquired HIV through homosexual transmission.In our study, INSTI use almost halved the risk of LEE compared with other regimens. This finding could be particularly important for choosing ART in patients with risk factors for liver toxicity such as HCV and HBV coinfections.