title: Increased risk of hepatotoxicity in HIV-infected pregnant women receiving antiretroviral therapy independent of nevirapine exposure.
abstract: OBJECTIVE
  To estimate whether the association between nevirapine (NVP) and hepatotoxicity differs according to pregnancy status in HIV-infected women.
  
  
  METHODS
  The present analysis included HIV-infected pregnant women on antiretroviral therapy (ART) from two multicenter, prospective cohorts - the Women and Infants Transmission Study and the International Maternal Pediatric Adolescent AIDS Clinical Trials protocol P1025 - and HIV-infected nonpregnant women from one multicenter, prospective cohort - the Women's Interagency HIV Study. Using multivariate Cox proportional hazards regression, the interaction between NVP and pregnancy status in terms of hepatotoxicity was investigated. NVP use was dichotomized as use or no use and was further categorized according to ART exposure history. We investigated two outcomes: any liver enzyme elevation (LEE; grade 1-4) and severe LEE (grade 3-4).
  
  
  RESULTS
  Data on 2050 HIV-infected women taking ART were included: 1229 (60.0%) pregnant and 821 (40.0%) nonpregnant. Among the pregnant women, 174 (14.2%) developed any LEE and 15 (1.2%) developed severe LEE as compared with 75 (9.1%) and 5 (0.6%), respectively, of the nonpregnant women. In multivariate adjusted models, NVP was not significantly associated with risk of LEE, regardless of pregnancy status; however, pregnancy was associated with an increased risk of any LEE (relative risk 4.7, confidence interval = 3.4-6.5) and severe LEE (relative risk 3.8, confidence interval = 1.3-11.1). The association of pregnancy and LEE was seen, regardless of prior ART and NVP exposure history.
  
  
  CONCLUSIONS
  No significant association between NVP and LEE was observed, regardless of pregnancy status, but pregnancy was significantly associated with increased hepatotoxocity in HIV-infected women.
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, USA. douyang@northshore.org
authors.forename: David W
authors.initials: DW
authors.lastname: Ouyang
authors.forename: David E
authors.initials: DE
authors.lastname: Shapiro
authors.forename: Ming
authors.initials: M
authors.lastname: Lu
authors.forename: Susan B
authors.initials: SB
authors.lastname: Brogly
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.forename: Robert M
authors.initials: RM
authors.lastname: Leighty
authors.forename: Bruce
authors.initials: B
authors.lastname: Thompson
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Tuomala
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Hershow
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000009:adverse effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D019829:Nevirapine