Incidence of nevirapine-associated hepatitis in an antenatal clinic.
OBJECTIVE
To describe the incidence, clinical presentation and management of nevirapine-associated hepatitis among antiretroviral-naïve pregnant women treated with nevirapine-based antiretroviral therapy at a dedicated antenatal antiretroviral clinic.


METHODS
Retrospective analysis of pregnant women initiated on nevirapine-based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006.


RESULTS
Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR) 26-32) years and median pre-treatment CD4 cell counts was 157 (IQR 104-193) cells/microl. Baseline alanine transaminase (ALT) was elevated in 2.8% of women (11/390). After initiation of nevirapine-based ART 8% (31/390) experienced an ALT elevation. Three of these patients developed clinical hepatitis with jaundice (0.8%, 3/390). The mean and median time to clinical presentation was 5 weeks. Hepatitis resolved following discontinuation of ART. Non-nevirapine regimens were initiated following biochemical and symptomatic improvement; symptoms did not recur.


CONCLUSIONS
Among pregnant women, nevirapine-containing ART has a favourable safety profile, with a low incidence of serious hepatic events.
Black
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Reproductive Health and HIV Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg.
Rees
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D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000554:Ambulatory Care Facilities; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007565:Jaundice / Q000139:chemically induced; D019829:Nevirapine / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011295:Prenatal Care; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013019:South Africa
D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; D000410:Alanine Transaminase