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JAC Advance Access published online on January 25, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl524
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

Liver toxicity induced by non-nucleoside reverse transcriptase inhibitors

Antonio Rivero1,*, José A. Mira2 and Juan A. Pineda3

1 Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Cordoba, Spain 2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Valme, Seville, Spain 3 Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain

* Corresponding author. Tel: +34-955011636; Fax: +34-955011636; E-mail: ariveror{at}saludalia.com

Liver toxicity is one of the most relevant adverse effects of antiretroviral therapy. Within the non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz can be considered a safer drug for the liver than nevirapine. In fact, the frequency of severe increased liver enzymes in patients on efavirenz ranges from 1 to 8%, whereas in patients treated with nevirapine, it ranges from 4 to 18%. Likewise, nevirapine is more commonly associated than efavirenz with early acute hepatitis, which is produced by a hypersensitivity mechanism and has a defined risk profile that often makes it avoidable. Despite the fact that most cases of NNRTI-induced liver toxicity are asymptomatic, the rates of symptomatic events in patients treated with nevirapine are greater than in subjects on efavirenz. In any case, it is unusual for an NNRTI to be suspended due to liver toxicity.

Key Words: efavirenz , nevirapine , hepatotoxicity , HIV


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