Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy.
OBJECTIVE
To describe the maternal tolerability of nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland and to determine risk factors for development of significant hepatotoxicity.


METHODS
A retrospective study was carried out of all women prescribed nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland (October 2000 to February 2003). Toxicities experienced were graded according to the Division of AIDS toxicity guidelines for adults. Statistical analysis was performed to determine whether there were differences between those that did and those that did not experience significant hepatotoxicity.


RESULTS
A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts (P=0.01).


CONCLUSIONS
In this cohort, women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts, lending additional weight to the need for caution in using nevirapine as part of combination antiretroviral therapy in women not requiring antiretroviral therapy for their own health.
Lyons
F
F
Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland. fionalyons69@yahoo.com.uk
Hopkins
S
S
Kelleher
B
B
McGeary
A
A
Sheehan
G
G
Geoghegan
J
J
Bergin
C
C
Mulcahy
F M
FM
McCormick
P A
PA
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D019829:Nevirapine / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000188:drug therapy; D011251:Pregnancy Complications, Infectious / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D019829:Nevirapine