final program.qxd - Parallels Plesk Panel

PP 4.23
The increased liver toxicity of nevirapine over efavirenz does not depend on the
female gender, and an initially elevated CD4+ lymphocyte count, in a single-centre
comparative study with efavirenz conducted on 720 overall patients
Roberto Manfredi, Leonardo Calza
Infectious Diseases, University of Bologna, Italy
Introduction. Some observations prompted to our attention a potentially increased
hepatotoxicy of nevirapine, with significant rise among women with a baseline CD4+
lymphocyte count >250 cells/µL. Aim of our study is to conduct an analysis from our
database of patients treated prospectically with either nevirapine or efavirenz, to better
define this claimed association. Patients and Methods. Among over 1,000 patients treated
with HAART for >12 months, the hepatotoxicity pattern of both NNRTI was assessed
according to three different backgrounds: antiretroviral-naïve patients starting a
NNRTI-based regimen; a large spectrum of patients experienced with two to ten
therapeutic lines (while remaining NNRTI-naïve); and finally subjects who added for the
first time a NNRTI only on late rescue therapies containing four drugs or more (and always
including protease inhibitors). Results. Three hundred and 34 patients treated with
nevirapine were compared with 386 individuals taking efavirenz in our survey, by a 12-30
months multivariate analysis of liver enzyme abnormalities, together with a varied
spectrum of epidemiological, clinical, and laboratory parameters. Instead of normal
laboratory levels, we referred to the values found at treatment start. The two study groups
were comparable as to epidemiological-clinical features and HIV virology, while a lower
CD4+ count was found in subjects starting efavirenz (p