Are the different classes of drugs responsible for different types of liver damage?
The nucleoside reverse transcriptase inhibitors, or NRTIs, cause enlargement of the liver, and a fat build-up in the liver called steatosis. Those patients, in some severe cases, also develop what we call lactic acidosis, which is a high level of acid in the blood that can result in significant problems, and even death. The nonnucleoside reverse transcriptase inhibitors, or NNRTIs, can also cause liver toxicity. One drug in this class has been associated with significant problems related to allergic reactions that can involve the liver, and destruction of the liver that has resulted in the death of some patients. When either occurs, it tends to occur within the first few weeks or first few months of therapy. Protease inhibitors, or PIs, have also been significantly associated with liver toxicities but the problem does not appear to be severe and, for the most part, it remains either temporary, or mild to moderate, and does not lead to the discontinuation of therapy. Some protease inhib
