Nevirapine Hepatotoxicity: Implications of Risk Factors

Abstract

Highly active antiretroviral therapy is used in the management of HIV/AIDS; it has contributed tremendously in the reduction of mortality and morbidity rate in HIV patients. Despite the outstanding achievement with the use of HAART its major limitation is toxicity. Among these toxicities is hepatotoxicity which is said to be associated with nevirapine containing highly active antiretroviral therapy. Recent reports have attributed nevirapine hepatotoxicity to some risk factors which includes genetic, gender, CD4 cell count, hepatitis and pregnancy in HIV patients which is of clinical concern. Available information on nevirapine hepatotoxicity and reported risk factors associated with nevirapine hepatotoxicity was collected and evaluated. In the light of available literature hepatitis B or C is observed to be a risk factor in HIV patients taking nevirapine containing regimens. Hepatitis B and or C/HIV co infection contribute to the progression of hepatotoxicity in HIV patients taking nevirapine containing regimens. The Human Lymphocyte Antigen (HLA) is the genetic element that is reported to drive nevirapine hepatotoxicity, but available information is sketchy to substantiate the involvement of HLA hence further evaluation is required. Pregnancy, Gender and CD4 cell count might not be risk factors in nevirapine hepatotoxicity but available body of knowledge showed discrepancies in reports which may warrant further evaluation. In this review no correlation was found between pregnancy, CD4 cell count and gender with respect to nevirapine associated hepatotoxicity but this leaves a space for further evaluation. Nevirapine should not be administered to HIV positive patients with hepatitis co infection except benefits out weights risk. When administered routine monitoring of liver function should be an objective.