Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection

AIDS. 2000 Dec 22;14(18):2895-902. doi: 10.1097/00002030-200012220-00011.


Objective: To investigate the risk of hepatotoxicity after initiation of protease inhibitor-containing highly active antiretroviral therapy (HAART) for HIV-1 infected patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infection.

Design: Retrospective study with 394 HIV-1-infected patients initiating HAART at a single university clinic.

Methods: Liver enzyme elevation (LEE) was defined as alanine aminotransferase or aspartate aminotransferase at least five times the upper limit of normal and an absolute increase of > 100 U/l. Relative risks for time to LEE were estimated using Cox proportional hazards models.

Results: Of 394 patients 7% were hepatitis B surface antigen (HBsAg)-positive and 14% were anti-HCV-positive. Patients with chronic hepatitis had a higher risk for LEE compared with patients without co-infection: 37% versus 12% respectively. After adjustment for higher baseline transaminases, the presence of HBsAg or anti-HCV remained associated with an increased risk of LEE - relative risk 2.78 (95% confidence interval, 1.50-5.16) and 2.46 (95% confidence interval, 1.43-4.24) respectively. In patients with LEE, transaminases declined whether HAART was continued or modified. Of patients with chronic HBV infection 38% lost HBeAg or developed anti-HBe after initiation of HAART, and one seroconverted from HBsAg-positive to anti-HBs-positive. However, there was no clear relationship with LEE.

Conclusions: HIV-1-infected patients co-infected with HBV or HCV were at considerably higher risk of developing LEE when HAART was initiated compared with patients without co-infection, but it is usually not necessary to modify antiretroviral therapy.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Alanine Transaminase / blood
  • Anti-HIV Agents / adverse effects*
  • Aspartate Aminotransferases / blood
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / etiology*
  • Drug Therapy, Combination
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV-1
  • Hepatitis B, Chronic / complications
  • Hepatitis C / complications
  • Humans
  • Liver Function Tests
  • Male
  • Reverse Transcriptase Inhibitors / adverse effects*


  • Anti-HIV Agents
  • Reverse Transcriptase Inhibitors
  • Aspartate Aminotransferases
  • Alanine Transaminase