ART, liver link in study

A UCT study has found that Efavirenz, a drug that forms part of many antiretroviral regimens, particularly in lowand middle-income countries, causes a pattern of druginduced liver injury (Dili).

The study found that severe Efavirenz liver injury could lead to death, even if the patient was healthy when starting antiretrovirals (ART). It pointed out that younger people and women were more at risk.

“The findings have important implications for developing world ART programmes, where millions are being commenced on Efavirenz-based ART regimens as criteria for initiation are expanded,” the study said.

Health Department spokesman Popo Maja said: “The department will apply its mind to the results of the study, and in consultation with the scientific community try to find an alternative but equally effective drug to fight HIV.” He said he had not been aware of that effect of Efavirenz.

The initial findings in the study, which was conducted by Professor Mark Sonderup, Graeme Meintjes, Wendy Spearman and four other doctors, were published to sensitise clinicians to the severe pattern of liver injury in patients receiving Efavirenz-based ART.

“We observed three patterns of injury, the most severe being submassive necrosis. A high baseline CD4+ seemingly predicts risk for submassive necrosis, with female gender and younger age additional factors. The associated morbidity and mortality is a serious concern,” the study said.

Sonderup, however, said Efavirenz remained an effective drug. “It is very important to understand that we are not telling people to stop using ARVs. ARVs save lives.”