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Hepatotoxicity tied to antiretroviral treatment in pregnant women

By David Douglas

WESTPORT, CT (Reuters Health) – Antiretroviral treatment of HIV infection may prompt hepatotoxicity in pregnant women, according to case reports in the November issue of Obstetrics and Gynecology.

In fact, lead author Dr. James B. Hill told Reuters Heath that "although combination antiretroviral therapy continues to be the recommended standard treatment for HIV-infected adults, there needs to be a heightened awareness for hepatotoxicity after initiation of therapy."

Dr. Hill and colleagues at the University of Texas Southwestern Medical Center at Dallas note that two of their patients developed hepatotoxicity after beginning antiretroviral therapy. Both were negative for hepatitis A, B, and C, Epstein-Barr virus and cytomegalovirus, and neither had a history of blood transfusion, alcohol or illicit drug use.

The first, a 28-year-old woman, was admitted to hospital for evaluation of nausea and vomiting at 18 weeks' gestation. This took place about 5 months after she started therapy with zidovudine, lamivudine and efavirenz. Among the findings were jaundice, hyperbilirubinemia and elevated serum aminotransferase levels.

Her antiretroviral treatment was discontinued and her condition began to improve. At 27 weeks' gestation she delivered a healthy infant. At 5 months after delivery her abnormal transaminases and hyperbilirubinemia had resolved and at follow-up the infant was HIV-negative.

The second patient, 22 years old, was diagnosed with HIV infection at 14 weeks' gestation. She exhibited signs and symptoms similar to those of the first patient 3 months after initiation of treatment with zidovudine, lamivudine and nelfinavir. Although she showed initial improvement after stopping antiretroviral therapy, she developed fulminant hepatic failure and died.

In light of these experiences, Dr. Hill concluded that in such patients "regular monitoring of liver function tests is recommended, and pregnant women are advised to seek care if signs of hepatotoxicity develop." Complications are serious, he added, "but luckily are very uncommon."

Obstet Gynecol 2001;98:909-911.

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