Pregnancy associated with hepatotoxicity regardless of nevirapine exposure, USA.
Article Type: Brief article
Subject: Nevirapine (Complications and side effects)
Highly active antiretroviral therapy (Complications and side effects)
Highly active antiretroviral therapy (Demographic aspects)
Pregnant women (Physiological aspects)
Liver diseases (Risk factors)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 236247768
Full Text: This article challenges the notion that nevirapine (a commonly used antiretroviral) is uniquely associated with hepatotoxicity during pregnancy. Data flora 2,050 HIV-positive pregnant and 1,229 HIV-positive non-pregnant women all on HAART from three large prospective cohort studies in the US showed that pregnancy itself was significantly associated with increased hepatotoxicity in HIV-positive women. The association was seen regardless of prior HAART and nevirapine exposure history. Contrary to previous reports, the investigators did not find an increase in hepatotoxicity among pregnant women exposed to nevirapine, including nevirapine-naive women with high CD4 cell counts. Pregnancy may provide a unique physiology that predisposes women to drug-induced hepatotoxicity. Consequently, whenever feasible, liver enzymes should be monitored among pregnant HIV-positive women on HAART. The findings are highly relevant for developing countries where nevirapine is a common component of first-line HAART, including during pregnancy. It is important to emphasise that the hepatotoxicity previously noted in patients taking continuous nevirapine has not been seen when nevirapine is used as a single, intrapartum dose. (1)

(1.) Ouyang DW, Shapiro DE, Lu M, et al. Increased risk of hepatotoxicity in HIV-infected pregnant women receiving antiretroviral therapy independent of nevirapine exposure. AIDS 2009; 23(18):2425-30.
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