Important note: Information in this article was accurate in February 2002. The state of the art may have changed since the publication date. 
Although the non-nuke nevirapine (Viramune) is an effective part of combination anti-HIV regimens, it is associated with a number of side effects, including the following:
As many as 17% of people exposed to this drug can develop a rash. In most cases, the rash is temporary. Nevirapine can also cause liver damage. Understanding how this happens is the focus of a research project in Madrid, Spain. The Spanish team suspects that nevirapine causes toxicity in two possible ways:
Researchers, led by infectious disease expert Vincent Soriano, enrolled 70 HIV positive subjects, all of whom were using nevirapine as part of triple anti-HIV drug therapy. Nevirapine was taken in a dose of 200 mg twice daily for up to one year.
In analysing the data, researchers divided subjects into two groups:
Among the 33 subjects who developed liver damage, liver enzymes usually rose an average of six months after they began to use nevirapine. Levels of nevirapine in the blood of these subjects were, on average, significantly higher than in subjects without liver damage.
Another factor that played a role in liver damage was infection with hepatitis C virus (HCV). Those subjects co-infected with HCV were at increased risk for nevirapine-associated liver damage than subjects who were not co-infected with HCV. Indeed, those subjects who were HCV positive and who had high levels of nevirapine in their blood had a 92% chance of developing liver damage.
Therapeutic drug monitoring for nevirapine levels, particularly in PHAs co-infected with HCV, may help alert doctors as to which of their patients are at risk for long-term nevirapine-associated liver problems.
REFERENCES
1. de Requena DG, Núñez M, Jiménez-Nácher I and Soriano V. Liver toxicity caused by nevirapine. AIDS 2002;16(2):290-291.
2. Martíneza E, Blancoa JL, Arnaizb JA, et al. Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy. AIDS 2001;15(10):1261-1268.
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