Nevirapine-associated hepatotoxicity and rash among HIV-infected pregnant women in Kenya.
BACKGROUND
Few studies have evaluated the risk of nevirapine (NVP)-associated hepatotoxicity among HIV-infected pregnant women with a CD4 count ≥250 cells/mm(3).


METHODS
We enrolled HIV-infected pregnant Kenyan women who initiated triple antiretroviral therapy (ART) at 34 weeks gestation. We compared the rates of severe hepatotoxicity (grades 3-4 hepatotoxicity) and rash-associated hepatotoxicity (rash with ≥grade 2 hepatotoxicity) with NVP and nelfinavir (NFV), respectively.


RESULTS
We initiated triple ART in 522 pregnant women; severe hepatotoxicity and rash-associated hepatotoxicity occurred in 14 (3%) and 9 (2%) women, respectively. Women who initiated NVP had higher rates of severe hepatotoxicity (5% vs 1%; P = .03) and rash-associated hepatotoxicity (4% vs 0%; P = .003) when compared with NFV. Among women who initiated NVP (n = 254), a baseline CD4 count ≥250 cells/mm(3) was not associated with severe hepatotoxicity (5% vs 3%; P = .52) or rash-associated hepatotoxicity (4% vs 3%; P = .69).


CONCLUSIONS
Nevirapine use but not CD4 count ≥250 cells/mm(3) was associated with hepatotoxicity.
1Centers for Disease Control and Prevention, Atlanta, GA, USA.
Philip J
PJ
Peters
Nicholas
N
Polle
Clement
C
Zeh
Rose
R
Masaba
Craig B
CB
Borkowf
Boaz
B
Oyaro
Paul
P
Omolo
Paul
P
Ogindo
Richard
R
Ndivo
Frank
F
Angira
Richard
R
Lando
Mary Glenn
MG
Fowler
Paul J
PJ
Weidle
Timothy K
TK
Thomas
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000209:etiology*; D003875:Drug Eruptions / Q000150:complications / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007630:Kenya; D019888:Nelfinavir / Q000009:adverse effects; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000276:immunology; D012307:Risk Factors; D055815:Young Adult
D019380:Anti-HIV Agents; D019829:Nevirapine; D019888:Nelfinavir