Rivero Antonio, Mira José A, Pineda Juan A
Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Cordoba, Spain.
J Antimicrob Chemother. 2007 Mar;59(3):342-6. doi: 10.1093/jac/dkl524. Epub 2007 Jan 25.
Liver toxicity is one of the most relevant adverse effects of antiretroviral therapy. Within the non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz can be considered a safer drug for the liver than nevirapine. In fact, the frequency of severe increased liver enzymes in patients on efavirenz ranges from 1 to 8%, whereas in patients treated with nevirapine, it ranges from 4 to 18%. Likewise, nevirapine is more commonly associated than efavirenz with early acute hepatitis, which is produced by a hypersensitivity mechanism and has a defined risk profile that often makes it avoidable. Despite the fact that most cases of NNRTI-induced liver toxicity are asymptomatic, the rates of symptomatic events in patients treated with nevirapine are greater than in subjects on efavirenz. In any case, it is unusual for an NNRTI to be suspended due to liver toxicity.
肝毒性是抗逆转录病毒疗法最相关的不良反应之一。在非核苷类逆转录酶抑制剂（NNRTIs）中，与奈韦拉平相比，依非韦伦对肝脏而言可被视为一种更安全的药物。事实上，服用依非韦伦的患者中严重肝酶升高的发生率在1%至8%之间，而接受奈韦拉平治疗的患者中这一发生率在4%至18%之间。同样，与依非韦伦相比，奈韦拉平更常与早期急性肝炎相关，后者由超敏反应机制引起，具有明确的风险特征，通常是可以避免的。尽管大多数由NNRTIs引起的肝毒性病例是无症状的，但接受奈韦拉平治疗的患者中出现症状性事件的发生率高于服用依非韦伦的患者。无论如何，因肝毒性而停用NNRTIs的情况并不常见。
