Hcv coinfection, an important risk factor for hepatotoxicity in pregnant women starting antiretroviral therapy

Summary Objectives This retrospective cohort study evaluated the risk of hepatotoxicity in HIV-1 positive pregnant and non-pregnant women starting combined ART. Methods Data were used from the ATHENA observational cohort. The study population consisted of HIV-1 infected, therapy naive, pregnant and non-pregnant women, followed between January 1997 and February 2008. Demographic, treatment and pregnancy related data were collected. Risk of hepatotoxicity was determined using univariate and multivariate logistic regression. Analyses were adjusted for age, region of origin, baseline HIV-RNA levels and CD4 cell counts, cART regimen and hepatitis B and C coinfection. ALT and AST values of more than 5 times ULN were considered as hepatotoxicity. Results Four-hundred and twenty-five pregnant and 1121 non-pregnant women were included. Independent risk factors of hepatotoxicity in all women were the presence of detectable HCV RNA (OR 5.48, 95% CI 2.25–13.38, p p p p p =0.02). Conclusion HCV coinfection and NVP use are associated with a higher risk of cART induced hepatotoxicity in pregnant women.