Case 2: Nevirapine-Induced Hepatotoxicity

Question | Discussion | References | CME Credit

You answered:

	The absence of rash makes nevirapine-associated hepatotoxicity extremely unlikely and thus nevirapine should be continued.

This answer is incorrect. The association of rash with nevirapine-induced hepatotoxicity is unpredictable, and the absence of rash certainly does not rule out nevirapine-associated hepatotoxicity. If nevirapine-induced rash is suspected, hepatic aminotransferase levels tests should be checked immediately to look for nevirapine-induced hepatotoxicity.

Choose another answer:

	The patient likely has nevirapine-induced hepatotoxicity. Antiretroviral therapy should be temporarily discontinued until symptoms resolve and hepatic aminotransferase levels return to baseline. Nevirapine should not be used again for this patient.
	The patient’s situation likely represents a mild and reversible reaction to nevirapine. Antiretroviral therapy should be continued with a reduced dose of nevirapine and the patient should receive prednisone (1 mg/kg/d) for 7 days. Hepatic aminotransferase levels should be monitored until laboratory and clinical symptoms resolve.
	The signs and symptoms are most consistent with immune reconstitution to chronic hepatitis C virus infection and the patient should receive prednisone (1 mg/kg/d) for 14 days. Nevirapine should not be discontinued.

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