Revista de SIDA e investigación clínica

Drug-Induced Liver Injury in HIV-Infected Patients with Opportunistic Infections: Causes, Clinical Features and Predictors in Chinese Patients

Abstract

Jiang Xiao, Shuxu Du, Guiju Gao, Di Yang and Hongxin Zhao

Objective: To evaluate the prevalence, causes, patterns, severity and risk factors of drug-induced liver injury (DILI) in Chinese HIV-infected patients with opportunistic infections.

Methods: HIV-infected patients with opportunistic infections with DILI were studied in Beijing Ditan Hospital between Jan.1, 2009 and Nov.30, 2012, and risk factors of DILI were evaluated using multivariate Cox Proportional Hazards Model.

Results: In 797 patients, 144 (18.1%) were diagnosed as DILI after receiving treatment of opportunistic infections or antiretroviral therapy. The leading causes were Trimethoprim/sulfamethoxazole (TMP-SMX) (43.9%), anti-tuberculosis medications (13.7%), nevirapine (6.9%), anti-fungal drugs (4.7%) and efavirenz (1.2%). The median duration between agents’ exposure and DILI recognition for hepatocellular, cholestatic and mixed pattern was statistically significant difference among 3 patterns of DILI (p=0.009), and the duration was positively correlated with CD4 count (r=0.223, p=0.007) and R value (r=0.238, p=0.004). Male sex and baseline CD4 counts were significant protective predictors for DILI.

Conclusion: TMP-SMX, anti-tuberculosis medications, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and anti-fungal drugs were the leading causes of DILI. The DILI in HIV-infected patients with opportunistic infections was negatively associated with male sex and CD4 counts.