Looking Beyond Highly Active Antiretroviral Therapy: Drug-Related Hepatotoxicity in Patients with Human Immunodeficiency Virus Infection
作者:Robert Orenstein、Nickolaos Tsogas
DOI:10.1592/phco.22.16.1468.33702
日期:2002.11
Management of human immunodeficiency virus (HIV) has become increasingly complex since the introduction of highly active antiretroviral therapy (HAART). Patients with HIV have become exposed to an increasing array of drugs to treat HIV, prevent opportunistic infections and immune dysfunction, and manage comorbid illnesses and therapeutic complications. Hepatic complications have become common and may lead to discontinuation of treatment and significant morbidity. Up to 90% of patients with acquired immunodeficiency syndrome (AIDS) receive at least one drug that can cause hepatotoxicity. Clinicians treating patients with HIV frequently face difficulty distinguishing abnormal liver transaminase levels and toxicities in patients receiving several drugs. Some potential causes of hepatic dysfunction are viral infections, alcohol and substance abuse, and hepatotoxic drugs such as HAART. Recent reports have focused on the hepatotoxicity of HAART and the role of hepatitis viruses to the exclusion of many other agents prescribed for patients with HIV. Many of the common antibiotics, antifungals, antivirals, and ancillary agents prescribed for patients with HIV are independently associated with hepatotoxicity. Clinicians should be aware of the potential non-antiretroviral hepatotoxic agents that are frequently administered in HIV management.
自从引入高效抗逆转录病毒疗法(HAART)以来,人类免疫缺陷病毒(HIV)的治疗变得越来越复杂。艾滋病病毒感染者需要使用越来越多的药物来治疗艾滋病病毒、预防机会性感染和免疫功能紊乱、控制合并症和治疗并发症。肝脏并发症已成为常见病,可能导致治疗中断和严重的发病率。高达 90% 的获得性免疫缺陷综合征(艾滋病)患者至少服用一种可引起肝毒性的药物。治疗艾滋病患者的临床医生经常难以区分肝脏转氨酶水平异常和接受多种药物治疗患者的毒性反应。导致肝功能异常的一些潜在原因包括病毒感染、酒精和药物滥用以及 HAART 等肝毒性药物。最近的报道主要集中在 HAART 的肝毒性和肝炎病毒的作用上,而忽略了其他许多为 HIV 患者开出的药物。许多为艾滋病患者处方的常用抗生素、抗真菌药、抗病毒药和辅助药物都与肝毒性有关。临床医生应了解在艾滋病治疗过程中经常使用的潜在非抗逆转录病毒肝毒性药物。