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Nevirapine complications in a naive patient

May 11, 2004

I wrote you a month before about the use of nevirapine vs efavirenz for a first regimen in a naive patient. Unfortunately it complicated with toxic hepatitis with ALT 708 and bilirrubin 9. I was admited to hospital for 9 days. Also I had acalculous chlecystitis. Doubts now are about the beginning of a new treatment. Even If liver function gets better do you think I'm at greater risk of developing hepatic disfunction than before ( I hav no other infections namely hepatis)? Could cholecystitis be explained also as a treatment complication? Again I thak you for your atention.

Response from Dr. Pierone

The toxic hepatitis from nevirapine (Viramune) generally occurs within the first several months of therapy and is due to a hypersensitivity reaction. Liver function typically returns to normal after the event and does not seem to predict a similar reaction to other antiretroviral medications or a greater risk of long-term liver problems. Acalculous cholecystitis means inflammation of the gallbladder in the absence of gallstones and could have been related to the liver inflammation (in view of the proximity).

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