Nevirapine-associated toxicity in HIV-infected Thai men and women, including pregnant women

Objectives The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HFV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). Methods NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/Iamivudine (3TC)/NVP from > 14 weeks of gestational age if their CD4 cell count was < 200 cells/mu L or from > 28 weeks if their CD4 cell count was > 200 cells/ mu L. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. Results Of 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P = 0.02 1). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts > 250 cells/mu L) had a significantly higher rate of symptomatic hepatotoxicity (P = 0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. Conclusions The incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.