Drug-Induced Liver Injury Associated with Antiretroviral Therapy that Includes HIV-1 Protease Inhibitors

[Guest guest]

Clinical Infectious Diseases 2004;38:S90-S97

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0008$15.00

Drug-Induced Liver Injury Associated with Antiretroviral Therapy that

Includes HIV-1 Protease Inhibitors

Mark S. Sulkowski

s Hopkins University School of Medicine, Baltimore, land

Since their introduction, hepatotoxicity has been associated with the use of

human immunodeficiency virus (HIV)1 protease inhibitors (PIs). However, the

complexity of the HIV-infected patient and the combinations of medications

used to treat HIV complicate the understanding of the independent effects of

PIs in the development of drug-induced liver injury (DILI). I discuss the

current understanding of PI-associated hepatotoxicity. Of the PI regimens

studied, the greatest risk of DILI has been observed among patients

receiving full-dose ritonavir. Similarly, hepatitis B and/or C virus

coinfection has been associated with a greater risk of DILI, compared with

those withno hepatitis. Although the specific mechanism by which viral

hepatitis increases this risk is not known, patients with cirrhosis may have

decreased cytochrome P450 activity, leading to increased PI exposure.

Clearly, further research is needed to define the interaction of PIs and

chronic viral hepatitis in the development of DILI.

[Guest guest]

Clinical Infectious Diseases 2004;38:S90-S97

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0008$15.00

Drug-Induced Liver Injury Associated with Antiretroviral Therapy that

Includes HIV-1 Protease Inhibitors

Mark S. Sulkowski

s Hopkins University School of Medicine, Baltimore, land

Since their introduction, hepatotoxicity has been associated with the use of

human immunodeficiency virus (HIV)1 protease inhibitors (PIs). However, the

complexity of the HIV-infected patient and the combinations of medications

used to treat HIV complicate the understanding of the independent effects of

PIs in the development of drug-induced liver injury (DILI). I discuss the

current understanding of PI-associated hepatotoxicity. Of the PI regimens

studied, the greatest risk of DILI has been observed among patients

receiving full-dose ritonavir. Similarly, hepatitis B and/or C virus

coinfection has been associated with a greater risk of DILI, compared with

those withno hepatitis. Although the specific mechanism by which viral

hepatitis increases this risk is not known, patients with cirrhosis may have

decreased cytochrome P450 activity, leading to increased PI exposure.

Clearly, further research is needed to define the interaction of PIs and

chronic viral hepatitis in the development of DILI.

[Guest guest]

Clinical Infectious Diseases 2004;38:S90-S97

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0008$15.00

Drug-Induced Liver Injury Associated with Antiretroviral Therapy that

Includes HIV-1 Protease Inhibitors

Mark S. Sulkowski

s Hopkins University School of Medicine, Baltimore, land

Since their introduction, hepatotoxicity has been associated with the use of

human immunodeficiency virus (HIV)1 protease inhibitors (PIs). However, the

complexity of the HIV-infected patient and the combinations of medications

used to treat HIV complicate the understanding of the independent effects of

PIs in the development of drug-induced liver injury (DILI). I discuss the

current understanding of PI-associated hepatotoxicity. Of the PI regimens

studied, the greatest risk of DILI has been observed among patients

receiving full-dose ritonavir. Similarly, hepatitis B and/or C virus

coinfection has been associated with a greater risk of DILI, compared with

those withno hepatitis. Although the specific mechanism by which viral

hepatitis increases this risk is not known, patients with cirrhosis may have

decreased cytochrome P450 activity, leading to increased PI exposure.

Clearly, further research is needed to define the interaction of PIs and

chronic viral hepatitis in the development of DILI.

[Guest guest]

Clinical Infectious Diseases 2004;38:S90-S97

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0008$15.00

Drug-Induced Liver Injury Associated with Antiretroviral Therapy that

Includes HIV-1 Protease Inhibitors

Mark S. Sulkowski

s Hopkins University School of Medicine, Baltimore, land

Since their introduction, hepatotoxicity has been associated with the use of

human immunodeficiency virus (HIV)1 protease inhibitors (PIs). However, the

complexity of the HIV-infected patient and the combinations of medications

used to treat HIV complicate the understanding of the independent effects of

PIs in the development of drug-induced liver injury (DILI). I discuss the

current understanding of PI-associated hepatotoxicity. Of the PI regimens

studied, the greatest risk of DILI has been observed among patients

receiving full-dose ritonavir. Similarly, hepatitis B and/or C virus

coinfection has been associated with a greater risk of DILI, compared with

those withno hepatitis. Although the specific mechanism by which viral

hepatitis increases this risk is not known, patients with cirrhosis may have

decreased cytochrome P450 activity, leading to increased PI exposure.

Clearly, further research is needed to define the interaction of PIs and

chronic viral hepatitis in the development of DILI.