Efavirenz induced acute liver failure requiring liver transplantation in a slow drug metaboliser

J Clin Virol. 2013 Sep;58(1):331-3. doi: 10.1016/j.jcv.2013.05.003. Epub 2013 Jun 12.

Abstract

Highly active antiretroviral therapy has revolutionised HIV management. However, many of these drugs are potentially hepatotoxic. Here, we report the first adult case of efavirenz induced acute liver failure successfully treated by liver transplantation. Furthermore, genetic analysis revealed our patient to be a slow efavirenz metaboliser, contributing to the severity of clinical presentation.

Keywords: ALF; ALP; ALT; Acute liver failure; CMV; CYP2B6; DILI; Drug induced liver injury; EFV; Efavirenz; HAART; HCV; HIV; Liver transplantation; NNRTI; NRTI; OLT; TDM; acute liver failure; alanine aminotransferase; alkaline phosphatase; cytomegalovirus; drug induced liver injury; efavirenz; hepatitis C virus; highly active antiretroviral therapy; human immunodeficiency virus; non-nucleoside reverse transcriptase inhibitor; nucleoside reverse transcriptase inhibitor; orthotopic liver transplantation; therapeutic drug monitoring.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Alkynes
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects*
  • Aryl Hydrocarbon Hydroxylases / genetics
  • Benzoxazines / administration & dosage
  • Benzoxazines / adverse effects*
  • Cyclopropanes
  • Cytochrome P-450 CYP2B6
  • Female
  • Genetic Predisposition to Disease
  • HIV Infections / drug therapy*
  • Humans
  • Liver Failure, Acute / chemically induced*
  • Liver Failure, Acute / surgery
  • Liver Transplantation*

Substances

  • Alkynes
  • Anti-HIV Agents
  • Benzoxazines
  • Cyclopropanes
  • Aryl Hydrocarbon Hydroxylases
  • CYP2B6 protein, human
  • Cytochrome P-450 CYP2B6
  • efavirenz