4 results on '"Lim, Joseph K."'
Search Results
2. Risk of Acute Liver Injury With Antiretroviral Therapy by Viral Hepatitis Status
- Author
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Gowda, Charitha, Newcomb, Craig W, Liu, Qing, Carbonari, Dena M, Lewis, James D, Forde, Kimberly A, Goldberg, David S, Reddy, K Rajender, Roy, Jason A, Marks, Amy R, Schneider, Jennifer L, Kostman, Jay R, Tate, Janet P, Lim, Joseph K, Justice, Amy C, Goetz, Matthew Bidwell, Corley, Douglas A, and Re, Vincent Lo
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Infectious Diseases ,Liver Disease ,HIV/AIDS ,Rare Diseases ,Prevention ,Digestive Diseases ,Chronic Liver Disease and Cirrhosis ,Emerging Infectious Diseases ,Clinical Research ,Hepatitis ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Infection ,Good Health and Well Being ,antiretroviral ,drug-induced liver injury ,hepatotoxicity ,HIV ,HIV. ,Clinical sciences ,Medical microbiology - Abstract
BackgroundThe risk of hepatotoxicity with antiretroviral therapy (ART) remains unknown. We determined the comparative risk of acute liver injury (ALI) for antiretroviral drugs, classes, and regimens, by viral hepatitis status.MethodsWe followed a cohort of 10 083 human immunodeficiency virus (HIV)-infected persons in Kaiser Permanente Northern California (n = 2099) from 2004 to 2010 and the Veterans Aging Cohort Study (n = 7984) from 2004 to 2012. Within the first year of ART, we determined occurrence of (1) liver aminotransferases >200 U/L and (2) severe ALI (coagulopathy with hyperbilirubinemia). We used Cox regression to determine hazard ratios (HRs) with 95% confidence intervals (CIs) of endpoints among initiators of nucleos(t)ide analogue combinations, antiretroviral classes, and ART regimens, all stratified by viral hepatitis status.ResultsLiver aminotransferases >200 U/L developed in 206 (2%) persons and occurred more frequently among HIV/viral hepatitis-coinfected than HIV-monoinfected persons (116.1 vs 20.7 events/1000 person-years; P < .001). No evidence of differential risk was found between initiators of abacavir/lamivudine versus tenofovir/emtricitabine among coinfected (HR, 0.68; 95% CI, .29-1.57) or HIV-monoinfected (HR, 1.19; 95% CI, .47-2.97) groups. Coinfected patients had a higher risk of aminotransferases >200 U/L after initiation with a protease inhibitor than nonnucleoside reverse-transcriptase inhibitor (HR, 2.01; 95% CI, 1.36-2.96). Severe ALI (30 events; 0.3%) occurred more frequently in coinfected persons (15.9 vs 3.1 events/1000 person-years; P < .001) but was too uncommon to evaluate in adjusted analyses.ConclusionsWithin the year after ART initiation, aminotransferase elevations were infrequently observed and rarely led to severe ALI. Protease inhibitor use was associated with a higher risk of aminotransferase elevations among viral hepatitis-coinfected patients.
- Published
- 2017
3. Predicting Risk of End-Stage Liver Disease in Antiretroviral-Treated Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients
- Author
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Re, Vincent Lo, Kallan, Michael J, Tate, Janet P, Lim, Joseph K, Goetz, Matthew Bidwell, Klein, Marina B, Rimland, David, Rodriguez-Barradas, Maria C, Butt, Adeel A, Gibert, Cynthia L, Brown, Sheldon T, Park, Lesley S, Dubrow, Robert, Reddy, K Rajender, Kostman, Jay R, Justice, Amy C, and Localio, A Russell
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Immunology ,HIV/AIDS ,Infectious Diseases ,Liver Disease ,Clinical Research ,Hepatitis ,Hepatitis - C ,Chronic Liver Disease and Cirrhosis ,Emerging Infectious Diseases ,Digestive Diseases ,Infection ,Good Health and Well Being ,end-stage liver disease ,hepatic decompensation ,HIV ,hepatitis C ,HIV/HCV coinfection ,Clinical sciences ,Medical microbiology - Abstract
Background. End-stage liver disease (ESLD) is an important cause of morbidity among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. Quantifying the risk of this outcome over time could help determine which coinfected patients should be targeted for risk factor modification and HCV treatment. We evaluated demographic, clinical, and laboratory variables to predict risk of ESLD in HIV/HCV-coinfected patients receiving antiretroviral therapy (ART). Methods. We conducted a retrospective cohort study among 6016 HIV/HCV-coinfected patients who received ART within the Veterans Health Administration between 1997 and 2010. The main outcome was incident ESLD, defined by hepatic decompensation, hepatocellular carcinoma, or liver-related death. Cox regression was used to develop prognostic models based on baseline demographic, clinical, and laboratory variables, including FIB-4 and aspartate aminotransferase-to-platelet ratio index, previously validated markers of hepatic fibrosis. Model performance was assessed by discrimination and decision curve analysis. Results. Among 6016 HIV/HCV patients, 532 (8.8%) developed ESLD over a median of 6.6 years. A model comprising FIB-4 and race had modest discrimination for ESLD (c-statistic, 0.73) and higher net benefit than alternative strategies of treating no or all coinfected patients at relevant risk thresholds. For FIB-4 >3.25, ESLD risk ranged from 7.9% at 1 year to 26.0% at 5 years among non-blacks and from 2.4% at 1 year to 14.0% at 5 years among blacks. Conclusions. Race and FIB-4 provided important predictive information on ESLD risk among HIV/HCV patients. Estimating risk of ESLD using these variables could help direct HCV treatment decisions among HIV/HCV-coinfected patients.
- Published
- 2015
4. Predicting Risk of End-Stage Liver Disease in Antiretroviral-Treated Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients.
- Author
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Lo Re, Vincent, Kallan, Michael J, Tate, Janet P, Lim, Joseph K, Goetz, Matthew Bidwell, Klein, Marina B, Rimland, David, Rodriguez-Barradas, Maria C, Butt, Adeel A, Gibert, Cynthia L, Brown, Sheldon T, Park, Lesley S, Dubrow, Robert, Reddy, K Rajender, Kostman, Jay R, Justice, Amy C, and Localio, A Russell
- Subjects
HIV ,HIV/HCV coinfection ,end-stage liver disease ,hepatic decompensation ,hepatitis C ,Liver Disease ,HIV/AIDS ,Digestive Diseases ,Chronic Liver Disease and Cirrhosis ,Hepatitis - C ,Emerging Infectious Diseases ,Clinical Research ,Hepatitis ,Infectious Diseases ,Infection - Abstract
Background. End-stage liver disease (ESLD) is an important cause of morbidity among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. Quantifying the risk of this outcome over time could help determine which coinfected patients should be targeted for risk factor modification and HCV treatment. We evaluated demographic, clinical, and laboratory variables to predict risk of ESLD in HIV/HCV-coinfected patients receiving antiretroviral therapy (ART). Methods. We conducted a retrospective cohort study among 6016 HIV/HCV-coinfected patients who received ART within the Veterans Health Administration between 1997 and 2010. The main outcome was incident ESLD, defined by hepatic decompensation, hepatocellular carcinoma, or liver-related death. Cox regression was used to develop prognostic models based on baseline demographic, clinical, and laboratory variables, including FIB-4 and aspartate aminotransferase-to-platelet ratio index, previously validated markers of hepatic fibrosis. Model performance was assessed by discrimination and decision curve analysis. Results. Among 6016 HIV/HCV patients, 532 (8.8%) developed ESLD over a median of 6.6 years. A model comprising FIB-4 and race had modest discrimination for ESLD (c-statistic, 0.73) and higher net benefit than alternative strategies of treating no or all coinfected patients at relevant risk thresholds. For FIB-4 >3.25, ESLD risk ranged from 7.9% at 1 year to 26.0% at 5 years among non-blacks and from 2.4% at 1 year to 14.0% at 5 years among blacks. Conclusions. Race and FIB-4 provided important predictive information on ESLD risk among HIV/HCV patients. Estimating risk of ESLD using these variables could help direct HCV treatment decisions among HIV/HCV-coinfected patients.
- Published
- 2015
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