Piroth L, Grappin M, Waldner A, Duong M, Buisson M, Chavanet P, Portier H; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1998 Sep 24-27; 38: 380 (abstract no. I-60).
University Hospital, Dijon, France.
Efficacy of highly-active antiretroviral therapy (HAART) has been demonstrated on immunological and virologic data and on clinical end-points. However, side-effects and toxicity are relatively frequent but not yet precisely evaluated in clinical practice. We followed-up 309 patients treated by HAART since April 1996. Main characteristics of these patients were as follows : 220 male - 89 female, mean age 39 years +/- 9.8, seropositive for HIV for 6.7 +/- 3.6 years, 26% coinfected with HCV and 14% with HBV. At the beginning of HAART, 82 were AIDS-patients. Median CD4 T-cell count was 315 [range : 0-1370], mean HIV viral load was 5.21 log10 [range : undetectable-6.63]. Median follow-up was 271 days. Twenty percent of patients were naive of antiretroviral therapy. Protease inhibitor initially administrated was indinavir (50%), saquinavir (27%) or ritonavir (23%). During follow-up, adverse effects justified a protease inhibitor change for 83 (26.9%) patients. Sixty five percent of changes occured in the first two months of HAART. Therapy was stopped for toxicity in 26.7 % of patients treated with indinavir, in 29.1% of these treated with ritonavir and in 3.7 % with saquinavir. Main adverse effects were gastro-intestinal (45 cases), urinary lithiasis (18 cases), neurologic effects (13 cases) and hepatitis (12 cases). Urinary lithiasis always occured in patients treated by indinavir, and most of reintroduction attempts were unsuccessful. Most of hepatitis were associated with ritonavir and HCV seropositivity. None of these patients was antigenemia HBS positive, and pre-treatement ALT levels did not seem predictive for hepatic toxicity. In conclusion, 1) major toxicity appears early after HAART initiation 2) HAART with ritonavir or indinavir are discontinued for toxicity in same proportions, even if reasons of treatment discontinuation are different 3) hepatitis C seropositivity must be taken into consideration before initiation of ritonavir therapy.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Anti-HIV Agents
- Antiretroviral Therapy, Highly Active
- CD4 Lymphocyte Count
- Drug Therapy, Combination
- Drug Toxicity
- Female
- HIV
- HIV Infections
- HIV Seropositivity
- Humans
- Indinavir
- Male
- Protease Inhibitors
- Ritonavir
- Saquinavir
- drug therapy
- surgery
- therapy
Other ID:
UI: 102188185
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