Liver failure in a child receiving highly active antiretroviral therapy and voriconazole

Area of Science:

• Pediatric Infectious Diseases
• Hepatology
• Clinical Pharmacology

Background:

• Acquired immunodeficiency syndrome (AIDS) in children requires long-term management with antiretroviral therapy.
• Voriconazole is a triazole antifungal agent used for invasive fungal infections.
• Co-administration of antiretrovirals and antifungals necessitates careful consideration of potential toxicities.

Observation:

• A 10-year-old child with vertically transmitted HIV infection was undergoing combination antiretroviral therapy.
• The child subsequently developed acute liver failure following the initiation of voriconazole treatment.
• This adverse event occurred despite ongoing antiretroviral management.

Findings:

• The temporal association suggests voriconazole may have contributed to or precipitated liver failure in this pediatric HIV patient.
• Potential mechanisms include drug-drug interactions between voriconazole and antiretroviral agents affecting hepatic metabolism.
• Underlying liver vulnerability in vertically HIV-infected children could increase susceptibility to drug-induced hepatotoxicity.

Implications:

• Clinicians should exercise caution when prescribing voriconazole to pediatric patients with HIV, especially those with potential pre-existing liver compromise.
• Close monitoring of liver function is crucial during concurrent therapy with voriconazole and antiretrovirals.
• Further research is warranted to elucidate the pharmacokinetic and pharmacodynamic interactions between these drug classes in pediatric populations.