Nevirapine with HCV History
Oct 5, 2004
Due to development of sensitive (painful)pronounced gynecomastia caused by efavirenz (taken in conjunction with abacavir & stavudine), we have opted to modify my protocol by replacing the efavirenz with nevirapine. I have a history of HCV infection (treated successfully with alpha interferon, ribavirin, supplemented with milk thistle, nac, & vitamin E). this treatment was terminated 2 years ago upon return of all liver enzymes to normal levels accompanied by several PCR's indicating HCV at undetectable levels. My question is whether it is safe - or if you would advise trying (with weekly blood testing during first 2 months to monitor liver function) to begin the nevirapine (one capsule daily for the first couple of weeks), and if using the nevirapine, are there any additional measures that can be implemented concommitantly to protect the liver (currently totally healthy - no fibrosis, cirrhosis, or inflamation) against any possible damage from the nevirapine.
Response from Dr. Conway
The switch you are contemplating is safe as long as your CD4 count is below 400 (if you are male) or 250 (if you are female). Below those levels, the risk of severe hepatic toxicity associated with nevirapine is extremely low. The HCV infection you carried is now cured and does not put you at any increased risk of hepatic toxicity due to nevirapine or anything else. As for monitoring, every 2 weeks will be fine, or more often should any symptoms develop. I would only do this for about 6 weeks, then after 6 more weeks (i.e. 3 months of treatment). If nothing has happened by then, hepatic problems with nevirapine rarely develop after that.
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