Multicenter study of skin rashes and hepatotoxicity in antiretroviral-naive HIV-positive patients receiving non-nucleoside reverse-transcriptase inhibitor plus nucleoside reverse-transcriptase inhibitors in Taiwan

doi:10.1371/journal.pone.0171596

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標題:	Multicenter study of skin rashes and hepatotoxicity in antiretroviral-naive HIV-positive patients receiving non-nucleoside reverse-transcriptase inhibitor plus nucleoside reverse-transcriptase inhibitors in Taiwan
作者:	Wu, Pei-Ying Cheng, Chien-Yu Liu, Chun-Eng Lee, Yi-Chien Yang, Chia-Jui Tsai, Mao-Song Cheng, Shu-Hsing Lin, Shih-Ping Lin, De-Yu Wang, Ning-Chi Lee, Yi-Chieh Sun, Hsin-Yun Tang, Hung-Jen Hung, Chien-Ching
貢獻者:	Natl Taiwan Univ Hosp, Ctr Infect Control Taoyuan Gen Hosp, Dept Internal Med, Minist Hlth & Welf Natl Yang Ming Univ, Sch Publ Hlth Changhua Christian Hosp, Dept Internal Med Ditmanson Med FdnChia Yi Christian Hosp, Dept Internal Med Natl Yang Ming Univ, Sch Med Far Eastern Mem Hosp, Dept Internal Med Taipei Med Univ, Sch Publ Hlth, Coll Publ Hlth & Nutr Taichung Vet Gen Hosp, Dept Internal Med Triserv Gen Hosp, Dept Internal Med Natl Def Med Coll Lotung Poh Ai Hosp, Med Lo Hsu Fdn, Dept Internal Med Natl Taiwan Univ Hosp, Dept Internal Med Natl Taiwan Univ, Coll Med Chi Mei Med Ctr, Dept Internal Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Natl Taiwan Univ, Dept Parasitol, Coll Med
關鍵字:	Transmitted Drug-Resistance Infected Patients Risk-Factors Hiv-1-Infected Patients Adverse Events Nevirapine Use Hepatitis-C Protease Inhibitors Clinical-Trials Virus-Infection
日期:	2017-02-21
上傳時間:	2018-11-30 15:55:35 (UTC+8)
出版者:	Public Library Science
摘要:	Objectives Two nucleos(t) ide reverse-transcriptase inhibitors (NRTIs) plus 1 non-NRTI (nNRTI) remain the preferred or alternative combination antiretroviral therapy (cART) for antiretroviral-naive HIV-positive patients in Taiwan. The three most commonly used nNRTIs are nevirapine (NVP), efavirenz (EFV) and rilpivirine (RPV). This study aimed to determine the incidences of hepatotoxicity and skin rashes within 4 weeks of initiation of cART containing 1 nNRTI plus 2 NRTIs. Methods Between June, 2012 and November, 2015, all antiretroviral-naive HIV-positive adult patients initiating nNRTI-containing cART at 8 designated hospitals for HIV care were included in this retrospective observational study. According to the national HIV treatment guidelines, patients were assessed at baseline, 2 and 4 weeks of cART initiation, and subsequently every 8 to 12 weeks. Plasma HIV RNA load, CD4 cell count and aminotransferases were determined. The toxicity grading scale of the Division of AIDS (DAIDS) 2014 was used for reporting clinical and laboratory adverse events. Results During the 3.5-year study period, 2,341 patients initiated nNRTI-containing cART: NVP in 629 patients, EFV 1,363 patients, and RPV 349 patients. Rash of any grade occurred in 14.1% (n = 331) of the patients. In multiple logistic regression analysis, baseline CD4 cell counts (per 100-cell/mu l increase, adjusted odds ratio [AOR], 1.125; 95% confidence interval [95% CI], 1.031-1.228) and use of NVP (AOR, 2.443; 95% CI, 1.816-3.286) (compared with efavirenz) were independently associated with the development of skin rashes. Among the 1,455 patients (62.2%) with aminotransferase data both at baseline and week 4, 72 (4.9%) developed grade 2 or greater hepatotoxicity. In multiple logistic regression analysis, presence of antibody for hepatitis C virus (HCV) (AOR, 2.865; 95% CI, 1.439-5.704) or hepatitis B surface antigen (AOR, 2.397; 95% CI, 1.150-4.997), and development of skin rashes (AOR, 2.811; 95% CI, 1.051-7.521) were independently associated with the development of hepatotoxicity. Conclusions The baseline CD4 cell counts and use of NVP were associated with increased risk of skin rashes, while hepatotoxicity was independently associated with HCV or hepatitis B virus coinfection, and development of skin rashes in antiretroviral-naive HIV-positive Taiwanese patients within 4 weeks of initiation of nNRTI-containing regimens.
關聯:	Plos One, v.12, n.2, e0171596
顯示於類別:	[保健營養系(所) ] 期刊論文

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