Abstracts

Rationale: Patients with AIDS and severe HCV-correlated hepatopathy show a high risk of developing epileptic seizures. Due to the comorbity and the treatment with antiretroviral therapies (ARV), the introduction of an AED (antiepileptic drug) therapy places several issues with regards to pharmacological interactions. Levetiracetam (LEV) is an effective newer AED, indicated in monotherapy. It is well tolerated and has a favourable pharmacological profile. Aim of our study was to evaluate the efficacy and tolerability of Levetiracetam in epileptic patients affected by AIDS and correlated HCV hepatitis and on antiretroviral treatment Methods: 59 patients evaluated (37 with AIDS and 22 with correlated HCV hepatitis). All patients presented acute symptomatic seizures and previously started an antiepileptic treatment (Topiramate, Carbamazepine, Oxcarbazepine, Valproic Acid, Phenobarbital) in association with ARV therapy. Considering pharmacokinetic and pharmacodynamic interactions which could lead to iatrogenic toxicity, incomplete viral load control and poor seizure control, LEV was introduced in all patients initially at least in monotherapy. In case of poor seizure control, Oxcarbazepine (OXC) was added. Mean LEV dosages were 2000 mg/day in monotherapy and 2750 mg/day as add-on therapy with OXC (mean OXC dose: 700 mg/day). Results: A) 36 patients (61%) were seizure free and among them 22 (61%) in LEV monotherapy and 14 (39%) in LEV-OXC therapy; B) 9 patients (16%) with LEV-OCX therapy reported 1-2 partial seizures every 6 months; C)14 patients (23%) with LEV-OXC therapy reported at least 1 seizure per month with a brief loss of contact, without tonic-clonic seizure or drop attack. Patients affected by correlated HCV hepatitis showed a better response than AIDS patients. Follow-up period was 48 months Conclusions: LEV was effective and well tolerated either in monotherapy or in polytherapy and none of the patients interrupted the treatment. The most common adverse event was somnolence (mild or moderate). Moreover, we report the positive association between LEV and OXC, which permits to maintain a low dosage of OXC. These results suggest that LEV is a good choice in the treatment of epileptic patients suffering from hepatopathy/AIDS and in therapy with ARV.