THe following anti-HIV drugs are known to cause 

“LIVER TOXICITY”

Aptivus	Atripla	Crixivan
Combivir	Emtriva	Epivir
Epzicom	Fortovase	Fuzeon
Hivid	Intelence	Isentress
Kaletra	Lexiva	Norvir
Prezista	Rescriptor	Retrovir
Reyataz	Selzentry	Sustiva
Trizivir	Truvada	Videx
Viramune	Viread	Ziagen

Zerit

Liver Toxicity causes liver failure.  Liver failure is now the leading cause of death among HIV patients who ingest HIV drugs.

Clin Infect Dis 32(3):492-497 (2001)

AIDS Res Hum Retroviruses 17(16):1467–1471 (2001)

Amy Justice,14th International AIDS Conference, Barcelona (2002a) (2002b)

HIV researchers have NOT identified HIV as a cause for liver toxicity or liver failure. Liver toxicity is exhibited by all classes of anti-HIV drugs.

JAIDS 32(3):259-267 (2003)

Viramune causes liver toxicity more often than other anti-HIV drugs. Clinically asymptomatic and symptomatic liver toxicity, including rapidly occurring fatal liver failure have been observed. Serious and fatal liver toxicity has been reported even during so-called post-exposure prophylaxis, where HIV-negative people were treated with a short-course of Viramune right after supposed exposure to HIV.

Toxic liver reactions occur at different time points for different drug classes:

• Nonnucleoside anti-HIV drugs (NNRTI) often cause a hypersensitivity REACTION within the first 12 weeks.
• Nucleoside analogs cause fatty liver, which is probably caused by mitochondrial toxicity and usually occurs after more than 6 months on treatment.
• The HIV protease inhibitors can cause liver toxicity at any time during the course of treatment.

Fulminant liver failure (acute liver failure) is one of the most challenging gastrointestinal emergencies encountered in clinical practice and encompasses a pattern of clinical symptoms that may lead to the rapid arrest of normal liver function. The syndrome is defined by the sudden onset of hepatic encephalopathy in an otherwise healthy individual. Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood. Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma.

Symptoms of Hepatic Encephalopathy

Breath with a musty or sweet odor Change in sleep patterns Changes in thinking Confusion that is mild, Forgetfulness Mental fogginess Personality or mood changes Poor concentration Poor judgment Loss of small hand movements

Abnormal movements or shaking of hands or arms Agitation, excitement, or seizures (occur rarely) Disorientation Drowsiness or confusion Inappropriate behavior or severe personality changes Slurred speech Slowed or sluggish movement

Hepatic encephalopathy often appears in association with defective blood clotting, jaundice and multi-system organ failure. (See Lactic Acidosis)