Which anti-HIV medications cause hepatotoxicity?
All FDA-approved NRTIs, NNRTIs, and PIs are associated with hepatotoxicity. NRTIs, especially Zerit (stavudine), Videx (didanosine), and Retrovir (zidovudine), are associated with lactic acidosis and hepatic steatosis. NNRTIs, especially Viramune (nevirapine), are associated with hepatitis and hepatic necrosis. If you and your doctor decide to use Viramune in your HIV treatment regimen, you will likely be instructed to take only one pill a day for the first 14 days, then to increase to two pills a day. This dosing schedule may decrease your risk of developing hepatotoxicity. Viramune-associated hepatotoxicity usually occurs within the first 12 weeks of taking the drug. Women appear to be at increased risk of liver damage. All patients starting therapy with Viramune should have LFTs every 2 weeks for the first month, then every month for the next 2 months, and then every 1 to 3 months throughout treatment. PIs, especially full-dose Norvir (ritonavir), are also associated with hepatotoxi
