Liver toxicity induced by non-nucleoside reverse transcriptase inhibitors.
Liver toxicity is one of the most relevant adverse effects of antiretroviral therapy. Within the non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz can be considered a safer drug for the liver than nevirapine. In fact, the frequency of severe increased liver enzymes in patients on efavirenz ranges from 1 to 8%, whereas in patients treated with nevirapine, it ranges from 4 to 18%. Likewise, nevirapine is more commonly associated than efavirenz with early acute hepatitis, which is produced by a hypersensitivity mechanism and has a defined risk profile that often makes it avoidable. Despite the fact that most cases of NNRTI-induced liver toxicity are asymptomatic, the rates of symptomatic events in patients treated with nevirapine are greater than in subjects on efavirenz. In any case, it is unusual for an NNRTI to be suspended due to liver toxicity.
Rivero
Antonio
A
Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Cordoba, Spain. ariveror@saludalia.com
Mira
José A
JA
Pineda
Juan A
JA
D000410:Alanine Transaminase / Q000097:blood; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D048588:Benzoxazines / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003521:Cyclopropanes; D004342:Drug Hypersensitivity; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology; D019829:Nevirapine / Q000009:adverse effects*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C098320:efavirenz