title: Hepatotoxicity with antiretroviral treatment of pregnant women.
abstract: BACKGROUND
  Hepatotoxicity in adults with human immunodeficiency virus (HIV) infection has been associated with all classes of antiretroviral drugs and coinfection with hepatitis B and C virus. We treated two HIV-infected pregnant women in whom hepatotoxicity developed after initiating antiretroviral therapy.
  
  
  METHODS
  The first woman developed icterus, jaundice, hyperbilirubinemia, and elevated serum aminotransferase levels approximately 5 months after beginning combination antiretroviral therapy with zidovudine, lamivudine, and efavirenz. Serum aminotransferase abnormalities improved after discontinuation of antiretroviral medications. The second woman had similar symptoms and laboratory abnormalities 3 months after initiation of zidovudine, lamivudine, and nelfinavir. Despite initial improvement after discontinuing her antiretroviral medications, fulminant hepatic failure developed and she died. Both patients tested negative for hepatitis A, B, and C; Epstein-Barr virus; and cytomegalovirus. There was no history of illicit drug use, alcohol use, or blood transfusions in either case.
  
  
  CONCLUSIONS
  We emphasize the need for careful monitoring for hepatotoxicity after initiation of antiretroviral therapy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA. james.hill@utsouthwestern.edu
authors.forename: J B
authors.initials: JB
authors.lastname: Hill
authors.forename: J S
authors.initials: JS
authors.lastname: Sheffield
authors.forename: G G
authors.initials: GG
authors.lastname: Zeeman
authors.forename: G D
authors.initials: GD
authors.lastname: Wendel
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents