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Acute Liver Toxicity due to Efavirenz/Emtricitabine/Tenofovir.

Patil R, Ona MA, Papafragkakis H, Carey J, Moshenyat Y, Alhaddad A, Anand S - Case Reports Hepatol (2015)

Bottom Line: The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug.We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, NY 11220, USA.

ABSTRACT
The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug. We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

No MeSH data available.


Related in: MedlinePlus

CT abdomen/pelvis without contrast showing heterogeneous liver parenchyma, no cirrhosis, and no ascites.
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fig1: CT abdomen/pelvis without contrast showing heterogeneous liver parenchyma, no cirrhosis, and no ascites.

Mentions: Upon admission, the liver enzymes were found to be elevated with an aspartate aminotransferase (AST) level of 1663 IU/L and an alanine aminotransferase (ALT) level of 1793 IU/L (Table 1). EFV/FTC/TDF was suspected to be related to the liver chemistry abnormalities and was held on the day of admission. On day two of the hospital course, he was transferred to the intensive care unit for closer monitoring because the liver enzymes continued to rise dramatically (AST 4297 IU/L and ALT 5346 IU/L). Despite the remarkably elevated aminotransferases, the total bilirubin was 0.6 mg/dL, alkaline phosphatase was 107 IU/L, and INR was 1.4, and he did not develop signs of hepatic encephalopathy. Acetaminophen level and urine drug screen were negative. Physical exam was remarkable only for mild right upper quadrant tenderness. A viral hepatitis panel was negative for hepatitis A, hepatitis B, and hepatitis C. Antimitochondrial antibodies and antinuclear antibodies were negative. Ceruloplasmin and alpha-1 antitrypsin were normal. Given the patient's normal CD4 count, undetectable viral load, and no suggestive findings on physical exam, hepatotropic viruses such as cytomegalovirus, Epstein Barr virus, herpes simplex virus, and varicella were considered less likely and therefore were not checked. Computed tomography (CT) scan showed heterogeneous liver parenchyma with no ascites and no evidence of cirrhosis (Figure 1). In consultation with poison control, the patient was started on the N-acetylcysteine protocol (10227 mg in 200 mL of D5 free water over one hour followed by 3409 mg/500 mL of D5 water over four hours followed by 6818 mg/1L D5 water over 16 hours). The patient was not treated with antibiotics during the hospital course or given any additional medications that might have slowed down the improvement of the liver biochemical tests.


Acute Liver Toxicity due to Efavirenz/Emtricitabine/Tenofovir.

Patil R, Ona MA, Papafragkakis H, Carey J, Moshenyat Y, Alhaddad A, Anand S - Case Reports Hepatol (2015)

CT abdomen/pelvis without contrast showing heterogeneous liver parenchyma, no cirrhosis, and no ascites.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4487274&req=5

fig1: CT abdomen/pelvis without contrast showing heterogeneous liver parenchyma, no cirrhosis, and no ascites.
Mentions: Upon admission, the liver enzymes were found to be elevated with an aspartate aminotransferase (AST) level of 1663 IU/L and an alanine aminotransferase (ALT) level of 1793 IU/L (Table 1). EFV/FTC/TDF was suspected to be related to the liver chemistry abnormalities and was held on the day of admission. On day two of the hospital course, he was transferred to the intensive care unit for closer monitoring because the liver enzymes continued to rise dramatically (AST 4297 IU/L and ALT 5346 IU/L). Despite the remarkably elevated aminotransferases, the total bilirubin was 0.6 mg/dL, alkaline phosphatase was 107 IU/L, and INR was 1.4, and he did not develop signs of hepatic encephalopathy. Acetaminophen level and urine drug screen were negative. Physical exam was remarkable only for mild right upper quadrant tenderness. A viral hepatitis panel was negative for hepatitis A, hepatitis B, and hepatitis C. Antimitochondrial antibodies and antinuclear antibodies were negative. Ceruloplasmin and alpha-1 antitrypsin were normal. Given the patient's normal CD4 count, undetectable viral load, and no suggestive findings on physical exam, hepatotropic viruses such as cytomegalovirus, Epstein Barr virus, herpes simplex virus, and varicella were considered less likely and therefore were not checked. Computed tomography (CT) scan showed heterogeneous liver parenchyma with no ascites and no evidence of cirrhosis (Figure 1). In consultation with poison control, the patient was started on the N-acetylcysteine protocol (10227 mg in 200 mL of D5 free water over one hour followed by 3409 mg/500 mL of D5 water over four hours followed by 6818 mg/1L D5 water over 16 hours). The patient was not treated with antibiotics during the hospital course or given any additional medications that might have slowed down the improvement of the liver biochemical tests.

Bottom Line: The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug.We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, NY 11220, USA.

ABSTRACT
The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug. We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

No MeSH data available.


Related in: MedlinePlus