Navigation Links
Vanishing bile duct syndrome secondary to anti-retroviral therapy in HIV
Date:7/30/2010

Vanishing bile duct syndrome (VBDS) refers to a group of disorders characterized by destruction and disappearance of intrahepatic (inside the liver) bile ducts. Multiple causes have been identified including infections, malignancies, autoimmune conditions and adverse effects of medications. The usual course of this condition is variable and many patients with VBDS respond to treatment of the underlying condition and/ or removal of the offending agent. However, others progress to cirrhosis and end stage liver disease requiring liver transplantation.

VBDS is rare in patients with HIV infection, and only one case has been reported in the literature, that of an HIV patient with advanced disease and cytomegalovirus infection. In addition, there are no reports of nevirapine, an anti-retroviral (anti-HIV) drug causing VBDS even though hepatotoxicity is an important side effect of the drug.

A case report to be published on July 14, 2010 in the World Journal of Gastroenterology describes VBDS secondary to nevirapine use in an HIV-positive, pregnant female. The patient received care at the University of Texas, Memorial Hermann Hospital and the Texas Liver Center in Houston by Dr. Rajan Kochar and colleagues. A 28-yr-old African American female in the 3rd trimester of pregnancy presented to the emergency room with jaundice and itching for 3 days. She also complained of pruritus, light colored stools and dark urine. She was diagnosed with HIV infection in 2000 and had not been on highly active anti-retroviral therapy (HAART) since 2003, but recently started triple drug therapy to minimize risk of vertical transmission with zidovudine, lamivudine and nevirapine 4 wk prior to presentation. She had no history of any opportunistic infections and was not taking any prophylactic medications. Liver tests were abnormal and after liver biopsy was performed, a diagnosis of vanishing bile duct syndrome (VBDS) was made. Liver transplant evaluation was subsequently initiated for the patient.

The most likely cause of VBDS in this patient was drug-induced liver injury (DILI). Nevirapine, a non-nucleoside reverse transcriptase inhibitor, is being increasingly used in pregnant patients owing to its favorable side effect profile and lower teratogenicity compared to protease inhibitors. However, hepatotoxicity is the major adverse effect of nevirapine (5%) and most often manifests as a hypersensitivity reaction with fever, rash and elevated liver tests within the first few weeks of therapy. Late onset hepatotoxicity after several weeks of nevirapine use has also been described in several cases and may be an idiosyncratic reaction to the drug. Although several case reports have demonstrated a cholestatic pattern of nevirapine toxicity, VBDS has never been reported. Ms. B did not have fever and rash, but had evidence of cholestatic hepatitis and a temporal association between nevirapine use and development of biochemical abnormalities. Therefore, nevirapine toxicity was felt to be the most likely cause of cholestasis and VBDS.

To the best of the authors' knowledge, this is the first reported case of nevirapine induced cholestatic hepatitis in a patient with HIV leading to severe ductopenia and VBDS. Therefore, VBDS should be considered in all HIV patients with chronic cholestasis, especially those with a history of nevirapine use. In addition, the possibility of this potentially irreversible adverse event should be kept in mind before making the decision to prescribe nevirapine.


'/>"/>

Contact: Lin Tian
wjg@wjgnet.com
86-105-908-0039
World Journal of Gastroenterology
Source:Eurekalert

Related medicine news :

1. Health Insurance Competition Vanishing: Study
2. Study finds structural brain alterations in patients with irritable bowel syndrome
3. LSUHSC study finds early predictors of metabolic syndrome in healthy 7-9 year-olds
4. Low vitamin D linked to the metabolic syndrome in elderly people
5. Upcoming Simulcast to Teach Women How to Lose Weight and Naturally Balance Hormones with Polycystic Ovarian Syndrome
6. Women with polycystic ovary syndrome have higher BPA blood levels
7. Metabolic syndrome in living kidney donors worsens function of remaining kidney
8. Vitamin D Deficiency Linked to Diabetes, Metabolic Syndrome in Studies
9. Renowned Geneticist Heralds in New Era for People with Down Syndrome
10. Women with Polycystic Ovarian Syndrome and Insulin Resistance can Lose Weight and Balance Hormones Naturally with Katie Humphrey's New E-book
11. Kids With Down Syndrome Might Get Help Learning
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/29/2017)... ... 2017 , ... The quest to develop a cure for HIV has long ... cured? The virus has a knack for lying dormant in immune cells at levels ... University of Pittsburgh’s Graduate School of Public Health announced today in Nature Medicine that ...
(Date:5/28/2017)... ... May 28, 2017 , ... Florida Pain Relief Group, a ... K. Cho, MD, has joined its Winter Haven practice. , Dr. Cho’s ... invasive techniques to treat and manage many types of pain. , Dr. ...
(Date:5/27/2017)... ... May 27, 2017 , ... In any business, follow up is critical to ... dental team at presenting treatment, there will always be some patients who can’t or ... money on best practices when it comes to presenting treatment. After the patient ...
(Date:5/26/2017)... ... 26, 2017 , ... The American Parkinson Disease Association’s ... grant submissions all vying for nearly $1,000,000 in funding that will be awarded ... American Parkinson Disease Association (APDA) is focused on advancing scientific research that will ...
(Date:5/26/2017)... Calif. (PRWEB) , ... May 26, 2017 , ... ... the integration of the CareFusion NOX-T3 portable sleep monitor with its Somnoware Sleep ... a consistent, browser-based interface for diagnostic device operations. With this platform, initializing devices ...
Breaking Medicine News(10 mins):
(Date:5/26/2017)... , May 26, 2017  Endo International plc (NASDAQ: ... President and CEO, will represent the Company in a fireside ... Conference on Tuesday, June 13, 2017 at 10:40 a.m. PT ... Terranea Resort in Rancho Palos Verdes, CA. ... the event will be available on the Company,s website at ...
(Date:5/22/2017)... 22, 2017  Lilac Corp, the company that ... launch of a new website . The ... a clinical study that showed surprising clearance of ... in individuals suffering from HPV warts, precancerous, or ... are no other treatments that clear the virus. ...
(Date:5/15/2017)... , May 15, 2017  Amy Baxter MD, ... industry leader in noninvasive pain relief, was awarded a ... magazine. Baxter was recognized at the MM&M Top ... New York City on May 10, 2017. ... the biopharma industry go "beyond the pill."  ...
Breaking Medicine Technology: