@article{PAR00004887,
  title = {{H}epatotoxicity and effectiveness of a {N}evirapine-based antiretroviral therapy in {HIV}-infected patients with or without viral hepatitis {B} or {C} infection in {C}ameroon},
  author = {{M}bougua, {J}.{B}.{T}. and {L}aurent, {C}hristian and {K}ouanfack, {C}. and {B}ourgeois, {A}nke and {C}iaffi, {L}. and {C}almy, {A}. and {G}wet, {H}. and {K}oulla-{S}hiro, {S}. and {D}ucos, {J}. and {M}poudi-{N}gole, {E}. and {M}olinari, {N}. and {D}elaporte, {E}ric},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {C}oinfection with hepatitis {B} virus ({HBV}) or hepatitis {C} virus ({HCV}) in {HIV}-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for {A}frican clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-{HIV} treatment. {W}e compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with {HIV} only and patients coinfected with hepatitis {B} or {C} virus in {C}ameroon. {M}ethods: {A} retrospective cohort study was conducted among {HIV}-1-infected patients. {P}lasma {HBV} {DNA} and {HCV} {RNA} were tested in positive or indeterminate samples for {HB}s{A}g or {HCV} antibodies, respectively. {A}ll patients received nevirapine and lamivudine plus stavudine or zidovudine. {R}esults: {O}f 169 {HIV}-1-infected patients with a median baseline {CD}4 count of 135 cells/mm(3) (interquartile range [{IQR}] 67 218), 21% were coinfected with {HBV} or {HCV}. {I}n coinfected patients, the median viral load was 2.47 x 107 {IU}/m{L} for {HBV} ({IQR} 3680-1.59 x 10(8)) and 928 000 {IU}/m{L} for {HCV} ({IQR} 178 400-2.06 x 10(6)). {M}ultivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). {T}he response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of {CD}4 cell count increase (p = 0.8), {HIV}-1 viral load below 400 copies/m{L} (p = 0.9), death (p = 0.3) and death or new {AIDS}-defining event (p = 0.1). {N}evirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. {C}onclusion: {T}his study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low {CD}4 cell count in {A}frica despite frequent coinfections with {HBV} or {HCV} and infrequent testing of these infections. {A}lthough testing for {HBV} and {HCV} should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown.},
  keywords = {{CAMEROUN}},
  booktitle = {},
  journal = {{BMC} {P}ublic {H}ealth},
  volume = {10},
  numero = {},
  pages = {105},
  ISSN = {1471-2458},
  year = {2010},
  DOI = {10.1186/1471-2458-10-105},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00004887},
}