01]. Finally, we observed that more hepatotoxic events occurred during the first year of NNRTI therapy compared with the entire period after 1 year (6.6 vs. 2.8 events, respectively, per 100 person-years of treatment; P = 0.04). Long-term NNRTI use was not associated with a higher risk of clinically significant liver toxicity in patients who had been treated with NNRTI for at least 3 years. Following the introduction of highly active antiretroviral therapy Small molecule library (HAART), the life expectancy of HIV-infected patients has increased dramatically. In view of the facts that

HAART is a life-long therapy and a successful regimen is intended to be used for many years, the long-term side effects of these antiretroviral drugs are receiving increasing attention. The nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz (EFV) and nevirapine (NVP) are frequently used as components of current antiretroviral regimens. However, NNRTIs are known for their potential to cause hepatotoxicity, which can lead to morbidity and therapy switches. Different studies have reported a cumulative

incidence of severe hepatotoxicity www.selleckchem.com/products/AT9283.html varying from 1.4 to 15.6% in patients treated with NVP [1-5] and from 1.1 to 10% in patients treated with EFV [1-4]. However, the follow-up time in these studies was relatively short, up to 3 years. Data focusing on hepatotoxicity in long-term NNRTI use are scarce [6]. The aim MTMR9 of this retrospective cohort analysis was to evaluate whether the incidence of hepatotoxicity increases with increasing duration of an NNRTI regimen. All HIV-infected patients under follow-up at our clinic until 1 November 2009, who had been receiving an NNRTI-containing HAART regimen for ≥ 3 years, were identified. Patients were included in the analysis if they had continuously used the same NNRTI for a minimum of three years and if at least one serum alanine transaminase (ALT) value per year was available throughout the treatment period. The control group consisted of patients who had exclusively received a protease inhibitor

(PI)-based regimen for at least 3 years and for whom ALT data were available. Demographic, pharmacological and laboratory data at the start of therapy were retrieved from the clinical database and patient records. Patients were considered to have a hepatitis B virus (HBV) infection when HBV DNA and/or the HBV surface antigen (HBsAg) was found at baseline. Hepatitis C virus (HCV) infection was defined as the detection of HCV RNA by polymerase chain reaction. Patients for whom baseline ALT was unknown and those with acute viral hepatitis during NNRTI treatment were excluded from the analysis. Hepatotoxicity was graded according to the modified toxicity scale of the AIDS Clinical Trials Group [1]. Serum ALT values were used rather than serum aspartate aminotransferase (AST) or cholestatic liver enzymes, as ALT is considered to be a more specific marker for liver damage [7].