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Obstetrics & Gynecology 2001;98:909-911
© 2001 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Hepatotoxicity With Antiretroviral Treatment of Pregnant Women

James B. Hill, MD, Jeanne S. Sheffield, MD, Gerda G. Zeeman, MD and George D. Wendel, Jr, MD

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas

Address reprint requests to: James B. Hill, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032; E-mail: james.hill{at}utsouthwestern.edu.

BACKGROUND: Hepatotoxicity in adults with human immunodeficiency virus (HIV) infection has been associated with all classes of antiretroviral drugs and coinfection with hepatitis B and C virus. We treated two HIV-infected pregnant 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 beginning combination antiretroviral therapy with zidovudine, lamivudine, and efavirenz. Serum aminotransferase abnormalities improved after discontinuation of antiretroviral medications. The second woman had similar symptoms and laboratory abnormalities 3 months after initiation of zidovudine, lamivudine, and nelfinavir. Despite initial improvement after discontinuing her antiretroviral medications, fulminant hepatic failure developed and she died. Both 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.






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