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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Nevirapine-associated hepatotoxicity was not predicted by CD4 count ≥250 cells/μL among women in Zambia, Thailand and Kenya
HIV Medicine, Volume 11, No. 10, Year 2010
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Description
Objective The aim of the study was to determine risk factors for developing severe hepatotoxicity (grade 3 or 4 hepatotoxicity) and rash-associated hepatotoxicity (rash with ≥grade 2 hepatotoxicity) among women initiating nevirapine-based antiretroviral therapy (ART).Methods The Non-Nucleoside Reverse Transcriptase Inhibitor Response Study was a prospective cohort study carried out in Zambia, Thailand and Kenya. Between May 2005 and January 2007, we enrolled antiretroviral-naïve HIV-infected women initiating nevirapine-based ART. At enrolment and at weeks 2, 4, 8, 16 and 24, participants had serum alanine transferase (ALT) and aspartate transaminase (AST) measured and were evaluated clinically for hepatitis and rash.Results Nevirapine-based ART was initiated in 820 women and baseline ALT or AST results were abnormal (≥grade 1) in 113 (14%) women. After initiating nevirapine-based ART, severe hepatotoxicity occurred in 41 (5%) women and rash-associated hepatotoxicity occurred in 27 (3%) women. In a multivariate logistic regression model, severe hepatotoxicity and rash-associated hepatotoxicity were both associated with baseline abnormal (≥grade 1) ALT or AST results, but not with a baseline CD4 cell count ≥250 cells/μL. Three participants (0.4%) died with symptoms suggestive of fatal hepatotoxicity; all three women had baseline CD4 count <100 cells/μL and were receiving anti-tuberculosis therapy.Conclusion Among women taking nevirapine-based ART, severe hepatotoxicity and rash-associated hepatotoxicity were predicted by abnormal baseline ALT or AST results, but not by a CD4 count ≥250 cells/μL. In resource-limited settings where transaminase testing is available, testing should focus on early time-points and on women with abnormal baseline ALT or AST results. © 2010 British HIV Association.
Authors & Co-Authors
Peters, Philip James
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Stringer, Jeffrey S.A.
United States, Birmingham
The University of Alabama at Birmingham
McConnell, Michelle S.
Taiwan
Thailand Ministry of Public Health-us Cdc Collaboration
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Kiarie, James Njogu
Kenya, Nairobi
University of Nairobi
Ratanasuwan, Winai
Thailand, Bangkok
Siriraj Hospital
Intalapaporn, Poj
Taiwan
Rajavithi Hospital
Potter, Dara
United States, Birmingham
The University of Alabama at Birmingham
Mutsotso, Winfred
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Zulu, Isaac S.
Zambia, Lusaka
Cdc-zambia
Borkowf, Craig B.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Bolu, Omotayo O.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Brooks, John T.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Weidle, Paul J.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Statistics
Citations: 40
Authors: 13
Affiliations: 8
Identifiers
Doi:
10.1111/j.1468-1293.2010.00873.x
ISSN:
14642662
e-ISSN:
14681293
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Kenya
Zambia
Participants Gender
Female