Antiretroviral-induced hepatotoxicity presenting as nonreassuring fetal testing

Combination antiretroviral therapy is recommended for pregnant women with human immunodeficiency virus (HIV) to decrease perinatal transmission. Treatment can cause mitochondrial dysfunction, leading to liver damage and acidosis. Early diagnosis is essential to improve outcome.

A multiparous woman with HIV-1 taking combination antiretroviral therapy presented with pneumonia at 28 weeks of gestation. Once treated, she improved clinically. However, nonreassuring fetal testing prompted further assessment, revealing maternal metabolic acidosis and transaminitis. Drug-induced hepatotoxicity was diagnosed, and combination antiretroviral therapy was discontinued. Fetal testing and maternal lab abnormalities subsequently improved.

Usual manifestations of hepatotoxicity and acidosis secondary to combination antiretroviral therapy include nausea, vomiting, and jaundice. In this case, nonreassuring fetal testing led to the diagnosis of hepatic dysfunction. Abnormal fetal testing can result from drug-related toxicity and warrants prompt assessment.