Naltrexone Has Little, if Any, Liver Toxicity in HIV-Infected Patients and Does Not Adversely Affect HIV Biomarkers
Naltrexone is a potentially useful treatment for alcohol and opioid dependence in HIV-infected patients, but its effect on liver enzymes and HIV biomarkers is not known. Researchers examined data from a national Veterans Affairs administrative, laboratory, and pharmacy database to identify HIV-infected patients who had received an initial oral naltrexone prescription of ≥7 days. Values for liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]), HIV viral load, and CD4 cell count were extracted and compared for 1 year before, during, and 1 year after naltrexone treatment. One hundred fourteen patients* received naltrexone for a median of 49 days.
- Values for AST and ALT were generally below the upper limit of normal before, during, and after naltrexone treatment regardless of whether the analysis included all 114 participants or only those with laboratory data for all 3 time periods (n=58).
- Only 2 cases of substantial liver enzyme elevation† occurred during naltrexone treatment; 1 case resolved after naltrexone discontinuation, while the other persisted for 33 days after naltrexone discontinuation.
- HIV viral load decreased and CD4 counts did not change after naltrexone treatment.
*Ninety-seven percent were men, 53% were black, 89% met criteria for alcohol dependence, and 57% were also infected with hepatitis C.
†Defined as ALT or AST >5 times baseline values or >3.5 times baseline values if baseline was >40 IU/L.
Comments:
This observational case series shows that liver toxicity is uncommon in HIV-infected patients treated with naltrexone. Importantly, naltrexone was not associated with a worsening of HIV biomarkers. Although this analysis was not designed to assess the impact of naltrexone on alcohol or opioid use, it does increase confidence that naltrexone can be safely used in HIV-infected individuals.
Kevin L. Kraemer, MD, MSc
Reference:
Tetrault JM, Tate JP, McGinnis KA, et al. Hepatic Safety and Antiretroviral Effectiveness in HIV-Infected Patients Receiving Naltrexone. Alcohol Clin Exp Res. July 28, 2011 [e-pub ahead of print]. doi: 10.1111/j.1530-0277.2011.01601.x.