Hepatotoxicity with antiretroviral treatment of pregnant women

BACKGROUND: Hepatotoxicity in adults with human immunodeficiency virus (MV) infection has been associated with all classes of antiretroviral drugs and coinfection with hepatitis B and C virus. We treated two MV-infected pregn ant women in whom hepatotoxicity developed after initiating antiretroviral therapy. CASES: The first woman developed icterus, jaundice, hyperbilirubinemia, and elevated serum aminotransferase levels approximately 5 months after beginn ing combination antiretroviral therapy with zidovudine, lamivudine, and efa virenz. Serum aminotransferase abnormalities improved after discontinuation . of antiretroviral medications. The second woman had similar symptoms and laboratory abnormalities 3 months after initiation of zidovudine, lamivudin e, and nelfinavir. Despite initial improvement after discontinuing her anti retroviral medications, fulminant hepatic failure developed and she died. B oth patients tested negative for hepatitis A, B, and C; Epstein-Barr virus; and cytomegalovirus. There was no history of illicit drug use, alcohol use , or blood transfusions in either case. CONCLUSION: We emphasize the need for careful monitoring for hepatotoxicity after initiation of antiretroviral therapy. (Obstet Gynecol 2001;98:909-11 . (C) 2001 by the American College of Obstetricians and Gynecologists.).