Nevirapine-associated hepatotoxicity and rash among HIV-infected pregnant women in Kenya

Abstract

Background: Few studies have evaluated the risk of nevirapine (NVP)-associated hepatotoxicity among HIV-infected pregnant women with a CD4 count ≥250 cells/mm3. 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/mm3 was not associated with severe hepatotoxicity (5% vs 3%; P =.52) or rash-associated hepatotoxicity (4% vs 3%; P =.69). Conclusion: Nevirapine use but not CD4 count ≥250 cells/mm3 was associated with hepatotoxicity. © The Author(s) 2012.