Nevirapine has been widely used in pregnancy for its efficacy, low pill burden, bioavailability and rapid transplacental transfer. Concern about nevirapine toxicity during pregnancy has emerged over recent years. ObjectivesThe aims of the study were to document the frequency of cutaneous and hepatic toxicity secondary to nevirapine use during pregnancy and to compare rates in women starting nevirapine during the current pregnancy with those in women who had commenced nevirapine prior to the current pregnancy. DesignThis was a retrospective, comparative, five-centre study carried out in London, UK, in 1997UK, in -2003. MethodsAll HIV-1-infected women who received nevirapine as part of combination antiretroviral therapy (ART) during pregnancy were included in the study. Data on demographics, HIV infection risk, Centers for Disease Control and Prevention (CDC) status, surrogate markers at initiation of therapy, other medications hepatitis B and C virus coinfection and clinical data relating to potential toxicity were collated and analysed. ResultsFifteen of 235 eligible women (6.4%) developed rash and eight (3.4%) developed hepatotoxicity, including four with coexistent rash, giving a combined incidence of 19 potential cases of nevirapine toxicity during pregnancy (8.1%). Alternative causes of rash/hepatotoxicity were suspected in seven cases and only 10 mothers (5.8%) discontinued nevirapine. Of the 170 women who commenced nevirapine during this pregnancy, 13 (7.6%) developed rash and eight (4.7%) hepatotoxicity, a combined incidence of 10%. Only two of 65 women with nevirapine exposure prior to this pregnancy developed rash (3.1%). ConclusionsNevirapine-containing ART was well tolerated in this cohort of pregnant women. Although pregnancy did not appear to increase the risk of nevirapine-associated toxicity compared to published adult data, CD 4 count may be less predictive of toxicity in pregnancy.Keywords: cutaneous side effects, hepatic side effects, nevirapine, pregnancy IntroductionThe use of antiretroviral therapy (ART) during pregnancy to minimize mother-to-child transmission of HIV-1 infection is well established [1,2]. Ideally, ART should be safe for mother and baby, effective and simple. Nevirapine has been widely used in pregnancy both as single-dose therapy during labour in resource-restricted settings and as part of short-and long-term highly active antiretroviral therapy (HAART). Physiological changes in pregnancy can significantly alter pharmacokinetics but nevirapine concentrations during pregnancy have been found to be comparable to those in nonpregnant adults [3,4]. Recent safety data on the use of nevirapine in pregnancy has given rise to concern. In the Paediatric AIDS Clinical Trials Group 1022 study, five of 17 subjects (29.4%) were reported to have an adverse event related to nevirapine, including one fatality from fulminant hepatitis [5]. Furthermore, a number of deaths in pregnancy among women taking nevirapine-containing ART have been reported to the Food and Drug Administration [6]. S...

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A patient with digital ischaemia and gangrene was treated with iloprost and antiplatelets for two weeks. His vasculitic screen was negative except for a positive HIV test. His vasculitis improved three weeks after treatment with antiretroviral medications. Though vasculitis is well known to be associated with HIV infection, very few cases of HIV present as vasculitis.

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Background/introductionWith recent commissioning changes, non NHS providers are increasingly being awarded contracts to manage services including HIV care. There is little data on patient views and experiences around this change.Aim(s)/objectivesTo obtain service user view of the aspects of the HIV service which they consider important in the landscape of commissioning changes.MethodsA patient survey was carried out in a community-based HIV service managed by a non-NHS provider. Questions were created to cover the most affected areas of the service due to the changes of HIV service provision.ResultsA representative sample of 44 attenders over 2 months undertook the survey; 34 men and 10 women. All were satisfied with the service. However some expressed concerns since change of provider, such as “services are being stripped off”, “not enough staff”, “standards have fallen”, “staff are under severe stress”. The proportion that rated the following aspects of the service as very important or important to patients are as follows: 24hour on-call service (98%), clinician access to investigation (95%), HIV team involvement in teaching wider NHS (98%) and current location (95%), HIV team involvement in their inpatient care (98%) and co-location of HIV and Sexual Health service (100%). The majority (86%) wanted an NHS provider, while 7% had no preference.Discussion/conclusionThe majority of patients preferred an NHS provider, with co-located Sexual Health services. They rated links with acute trust and the wider NHS as important aspects of their care. This needs to be considered while commissioning, planning and delivering future services.