indinavir-sulfate and Hepatitis-B

A HIV-1 patient database was scanned in March 1998, and 750 patients were identified who had received HAART including indinavir. Of these, 28 cases had nephrolithiasis; and 85 asymptomatic indinavir-treated patients were randomly selected as controls. The characteristics of cases and controls were compared by analysis of variance for quantitative parameters and by Fisher's exact test for classes.. We observed a significant increase in the incidence of nephrolithiasis in patients co-infected with HIV-1 and either hepatitis C virus (HCV) (HCV RNA-positive) or hepatitis B virus (HBV) (HBs antigen-positive) (odds ratio and 95% confidence intervals: 2.8 and 1.1-7.7), whereas no significant differences were demonstrated between cases and controls with regard to age (42.4 +/- 8.0 versus 39.8 +/- 9.8 years), sex (male patients 70.4 versus 74.1%), duration of HIV-1 infection (8.6 +/- 3.1 versus 7.7 +/- 4.0 years), duration of indinavir treatment (16.1 +/- 5.8 versus 14.1 +/- 5.4 months), AST increase > or = 1.25 of normal (29.6 versus 25.9%), or ALT increase > or = 1.25 of normal (33.3 versus 22.4%). In co-infected patients, ALT increase (> or = 1.25 of normal), but not AST increase, at the time of indinavir initiation was statistically related to the occurrence of nephrolithiasis.. We found a significant increase of nephrolithiasis incidence in patients co-infected with HIV-1 and HCV or HBV, which suggests that underlying multifactorial hepatic damage may limit liver catabolism of indinavir, and consequently increase its renal excretion and the risk of nephrolithiasis. Caution is therefore advised when initiating indinavir treatment in HIV patients with evidence of HBV or HCV infection.

Topics: Adult; Anti-HIV Agents; Case-Control Studies; Databases, Factual; Drug Therapy, Combination; Female; Hepatitis B; Hepatitis C; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Incidence; Indinavir; Kidney Calculi; Male; Middle Aged; Reverse Transcriptase Inhibitors

Topics: Adult; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; Follow-Up Studies; Hepatitis B; Hepatitis C; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Indinavir; Liver Function Tests; Male; Ritonavir

Gilead Sciences has seen beneficial results from two trials of adefovir dipivoxil (Preveon) in the treatment of HIV. An additional trial of adefovir dipivoxil was a success, dramatically reducing hepatitis B viral load by 99.99 percent. GS 411 assigned treatment-naive patients to one of five regimens that included indinavir (Crixivan) and adefovir. The results suggest that adefovir, which is metabolized differently and has different side effects, may be an alternative for some nucleoside analogs. GS 408 added adefovir to the regimens of treatment-experienced patients and showed a marked decrease in viral load for those patients who used adefovir versus a placebo. Adefovir dipivoxil may also be used effectively against other viruses such as CMV, HHV6 and Epstein-Barr. Long-term effectiveness in controlling the HIV virus has yet to be determined.

Topics: Adenine; Anti-HIV Agents; Antiviral Agents; Clinical Trials as Topic; Drug Therapy, Combination; Drugs, Investigational; Hepatitis B; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; United States