ObjectivesThe aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). MethodsNVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from 414 weeks of gestational age if their CD4 cell count was 200 cells/mL or from 428 weeks if their CD4 cell count was 4200 cells/mL. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. ResultsOf 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P 5 0.021). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts 4250 cells/mL) had a significantly higher rate of symptomatic hepatotoxicity (P 5 0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. ConclusionsThe incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.

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Poster abstracts of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory. P46.10 Changes in the ductus venosus in fetuses with growth restrictionA. Chanthasenanont, D. Pongrojpaw, C. H. Somprasit, K. Suwannarurk, S. Manusook, P. Assadongpongpana, J. Kotchasit, A. Kamudhamas Thammasat University, ThailandObjectives: To demonstrate differences in the diameter and pulsatility index (PI) of the ductus venosus (DV) and in the cerebroplacental ratio (CPR) in fetuses with intrauterine growth restriction (IUGR). Methods: This was a cross-sectional cohort study at Thammasat University Hospital. At least three measurements were made in each fetus during fetal quiescence. The fetuses with IUGR were classified as a study group. Controls were matched by gestational age (GA). Abnormal DV diameter or PI was defined as greater than the 95 th percentile for GA. Abnormal CPR defined as less than 1.08. All fetuses were compared with GA matched normal fetal Doppler studies. Results: Thirty-three fetuses with IUGR were compared against 33 normal fetuses. There was significantly more abnormal DV diameter in the study group (P = 0.01). Of study group, 6/33 had abnormal DV diameter, while three of 33 had abnormal DV PI. There were 2/33 cases of abnormal CPR; all had ...

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