Abstract
We report 2 cases illustrating that it is too simplistic to link nevirapine (NVP) toxicity exclusively to individuals with immune preservation. Not enough is known about the mechanism of hepatotoxicity or cutaneous eruption to predict these events. This type of hypersensitivity reaction occurs rarely among HIV-exposed infants taking NVP prophylaxis or antiretroviral therapy (ART)-experienced adults with complete plasma viral load suppression. Conversely, HIV-uninfected adults and ART-naive pregnant women appear to be disproportionately affected by the adverse effects of NVP.
Highlights
Over the last decade, South Africa (SA) has made major progress in the prevention of mother-to-child transmission (PMTCT) of HIV
The handful of cases of birth defects that may be associated with EFV use are widely discussed, much less attention has been given to reports of much more common toxicities associated with NVP use
We report 2 recent cases of maternal deaths at our institution, both from liver failure, following initiation of NVP-based antiretroviral therapy (ART)
Summary
South Africa (SA) has made major progress in the prevention of mother-to-child transmission (PMTCT) of HIV. This increase coincided with the release of the 2010 SA PMTCT guidelines[4] that promoted nevirapine (NVP)-based ART for pregnant women with World Health Organization (WHO) clinical stage 3 or 4 disease, regardless of CD4 cell count, hepatitis B infection, the presence of abnormal liver transaminases, or the need for tuberculosis co-treatment.
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