Drug Safety

, Volume 32, Issue 2, pp 147–158

Hepatotoxicity Associated with Long-versus Short-Course HIV-Prophylactic Nevirapine Use

A Systematic Review and Meta-Analysis from the Research on Adverse Drug events And Reports (RADAR) Project
  • June M. McKoy
  • Charles L. Bennett
  • Marc H. Scheetz
  • Virginia Differding
  • Kevin L. Chandler
  • Kimberly K. Scarsi
  • Paul R. Yarnold
  • Sarah Sutton
  • Frank Palella
  • Stuart Johnson
  • Eniola Obadina
  • Dennis W. Raisch
  • Jorge P. Parada
Original Research Article

DOI: 10.2165/00002018-200932020-00007

Cite this article as:
McKoy, J.M., Bennett, C.L., Scheetz, M.H. et al. Drug-Safety (2009) 32: 147. doi:10.2165/00002018-200932020-00007

Abstract

Background and objective: The antiretroviral nevirapine can cause severe hepatotoxicity when used ‘off-label’ for preventing mother-to-child HIV transmission (PMTCT), newborn post-exposure prophylaxis and for pre- and post-exposure prophylaxis among non-HIV-infected individuals. We describe the incidence of hepatotoxicity with short-versus long-course nevirapine-containing regimens in these groups.

Methods: We reviewed hepatotoxicity cases among non-HIV-infected individuals and HIV-infected pregnant women and their offspring receiving short- (≤4 days) versus long-course (≥5 days) nevirapine prophylaxis. Sources included adverse event reports from pharmaceutical manufacturers and the US FDA, reports from peer-reviewed journals/scientific meetings and the Research on Adverse Drug events And Reports (RADAR) project. Hepatotoxicity was scored using the AIDS Clinical Trial Group criteria.

Results: Toxicity data for 8216 patients treated with nevirapine-containing regimens were reviewed. Among 402 non-HIV-infected individuals receiving short- (n = 251) or long-course (n = 151) nevirapine, rates of grade 1–2 hepatotoxicity were 1.99% versus 5.30%, respectively, and rates of grade 3–4 hepatotoxicity were 0.00% versus 13.25%, respectively (p < 0.001 for both comparisons). Among 4740 HIV-infected pregnant women receiving short- (n = 3031) versus long-course (n=1709) nevirapine, rates of grade 1–2 hepatotoxicity were 0.62% and 7.04%, respectively, and rates of grade 3–4 hepatotoxicity were 0.23% versus 4.39%, respectively (p< 0.001 for both comparisons). The rates of grade 3–4 hepatotoxicity among 3074 neonates of nevirapine-exposed HIV-infected pregnant women were 0.8% for those receiving short-course (n = 2801) versus 1.1 % for those receiving long-course (n=273) therapy (p < 0.72).

Conclusions: Therapy duration appears to significantly predict nevirapine hepatotoxicity. Short-course nevirapine for HIV prophylaxis is associated with fewer hepatotoxic reactions for non-HIV-infected individuals or pregnant HIV-infected women and their offspring, but administration of prophylactic nevirapine for ≥2 weeks appears to be associated with high rates of hepatotoxicity among non-HIV-infected individuals and HIV-infected pregnant mothers. When full highly active antiretroviral therapy (HAART) regimens are not available, single-dose nevirapine plus short-course nucleoside reverse transcriptase inhibitors to decrease the development of HIV viral resistance is an essential therapeutic option for PMTCT and these data support the safety of single-dose nevirapine in this setting.

Supplementary material

40264_2012_32020147_MOESM1_ESM.pdf (157 kb)
Supplementary material, approximately 161 KB.

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • June M. McKoy
    • 1
    • 2
  • Charles L. Bennett
    • 3
  • Marc H. Scheetz
    • 4
    • 5
  • Virginia Differding
    • 3
  • Kevin L. Chandler
    • 3
  • Kimberly K. Scarsi
    • 4
  • Paul R. Yarnold
    • 3
  • Sarah Sutton
    • 3
  • Frank Palella
    • 3
  • Stuart Johnson
    • 6
  • Eniola Obadina
    • 3
  • Dennis W. Raisch
    • 7
  • Jorge P. Parada
    • 6
  1. 1.Department of Medicine, Member Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Preventive Medicine, Member Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Department of Pharmacy b]Northwestern Memorial HospitalChicagoUSA
  5. 5.Department of Pharmacy PracticeMidwestern UniversityDowners GroveUSA
  6. 6.Department of MedicineStritch School of Medicine-Loyola UniversityChicagoUSA
  7. 7.VA Cooperative Studies Program Clinical Research PharmacyAlbuquerqueUSA

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