Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy
Objectives. To describe the clinical characteristics of patients presenting with fulminant liver failure after varying periods of exposure to Efavirenz containing antiretroviral medications. Methods. We report a series of 4 patients with human immunodeficiency virus (HIV) infection who were admitted...
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Wiley
2018-01-01
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| Series: | Case Reports in Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2018/1270716 |
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| author | Innocent Lule Segamwenge Miriam Kaunanele Bernard |
| author_facet | Innocent Lule Segamwenge Miriam Kaunanele Bernard |
| author_sort | Innocent Lule Segamwenge |
| collection | DOAJ |
| description | Objectives. To describe the clinical characteristics of patients presenting with fulminant liver failure after varying periods of exposure to Efavirenz containing antiretroviral medications. Methods. We report a series of 4 patients with human immunodeficiency virus (HIV) infection who were admitted with acute liver failure (ALF) over a 6-month period. All these patients had been treated with a range of Efavirenz containing antiretroviral regimens and were negative for hepatitis A, B, and C infections as well as other opportunistic infections, all were negative for autoimmune hepatitis, and none had evidence of chronic liver disease or use of alcohol or herbal medications. Information on patient clinical characteristics, current antiretroviral regimen, CD4 count, HIV-1 RNA levels, and clinical chemistry parameters was collected. Informed consent was provided. Results. During a 6-month period, four patients without other known risk factors for acute hepatitis presented with symptomatic drug-induced liver injury with varying symptoms and outcomes. The pattern of liver injury was hepatocellular for all the 4 cases. Liver biopsies were done for all the four cases and the results showed a heavy mixed inflammatory cell infiltrate with eosinophils. For three patients withdrawal of Efavirenz from their antiretroviral regimen was sufficient to restore transaminase levels to normal and led to improvement of clinical symptoms. For one patient his clinical course was characterized by fulminant liver failure and fluctuating episodes of hepatic encephalopathy which ultimately resulted in his death. Conclusion. Hepatotoxicity of Efavirenz is not as rare as previously described in the literature and does actually present with fatal outcomes. The key message to note is that frequent monitoring of liver enzymes should be done at initiation of antiretroviral therapy and should continue throughout the treatment period. |
| format | Article |
| id | doaj-art-30d655e667b541928eb271adc61b5485 |
| institution | Kabale University |
| issn | 2090-6587 2090-6595 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Case Reports in Hepatology |
| spelling | doaj-art-30d655e667b541928eb271adc61b54852025-02-03T05:57:42ZengWileyCase Reports in Hepatology2090-65872090-65952018-01-01201810.1155/2018/12707161270716Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral TherapyInnocent Lule Segamwenge0Miriam Kaunanele Bernard1Department of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, NamibiaDepartment of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, NamibiaObjectives. To describe the clinical characteristics of patients presenting with fulminant liver failure after varying periods of exposure to Efavirenz containing antiretroviral medications. Methods. We report a series of 4 patients with human immunodeficiency virus (HIV) infection who were admitted with acute liver failure (ALF) over a 6-month period. All these patients had been treated with a range of Efavirenz containing antiretroviral regimens and were negative for hepatitis A, B, and C infections as well as other opportunistic infections, all were negative for autoimmune hepatitis, and none had evidence of chronic liver disease or use of alcohol or herbal medications. Information on patient clinical characteristics, current antiretroviral regimen, CD4 count, HIV-1 RNA levels, and clinical chemistry parameters was collected. Informed consent was provided. Results. During a 6-month period, four patients without other known risk factors for acute hepatitis presented with symptomatic drug-induced liver injury with varying symptoms and outcomes. The pattern of liver injury was hepatocellular for all the 4 cases. Liver biopsies were done for all the four cases and the results showed a heavy mixed inflammatory cell infiltrate with eosinophils. For three patients withdrawal of Efavirenz from their antiretroviral regimen was sufficient to restore transaminase levels to normal and led to improvement of clinical symptoms. For one patient his clinical course was characterized by fulminant liver failure and fluctuating episodes of hepatic encephalopathy which ultimately resulted in his death. Conclusion. Hepatotoxicity of Efavirenz is not as rare as previously described in the literature and does actually present with fatal outcomes. The key message to note is that frequent monitoring of liver enzymes should be done at initiation of antiretroviral therapy and should continue throughout the treatment period.http://dx.doi.org/10.1155/2018/1270716 |
| spellingShingle | Innocent Lule Segamwenge Miriam Kaunanele Bernard Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy Case Reports in Hepatology |
| title | Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy |
| title_full | Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy |
| title_fullStr | Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy |
| title_full_unstemmed | Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy |
| title_short | Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy |
| title_sort | acute liver failure among patients on efavirenz based antiretroviral therapy |
| url | http://dx.doi.org/10.1155/2018/1270716 |
| work_keys_str_mv | AT innocentlulesegamwenge acuteliverfailureamongpatientsonefavirenzbasedantiretroviraltherapy AT miriamkaunanelebernard acuteliverfailureamongpatientsonefavirenzbasedantiretroviraltherapy |