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May 17, 2000

Elevated Liver Enzymes Following Initiation of Antiretroviral Therapy—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(19):2526-2527. doi:10.1001/jama.283.19.2521

In Reply: We agree with Drs Velasco and Guijarro that serum aminotransaminase level elevations following the initiation of ART could reflect immune reconstitution, as we discussed. However, there are a number of reasons to suspect that the majority of significant liver enzyme elevations in our study were due to medication toxicity. Liver enzyme elevations occurred more often in persons receiving a specific drug, ritonavir, an effect that was independent of effectiveness of the medication in suppressing HIV replication. In addition, 14% of persons with ritonavir-associated hepatotoxicity did not have effective suppression of HIV replication or increases in CD4 cell count, findings that essentially exclude immune reconstitution in these cases.

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