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EFV/FTC/TDF-associated hepatotoxicity: a case report and review
Ignacio A Echenique1, Josiah D Rich
1Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA. ignacio.echenique@northwestern.edu
AIDS Patient Care and Stds
|August 14, 2013
Summary
This case report details a patient experiencing liver injury from efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF), a common HIV treatment. Discontinuation of the drug resolved the liver issues, highlighting a rare adverse effect.
Area of Science:
- Hepatology
- Infectious Diseases
- Pharmacology
Background:
- The fixed-dose combination efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF) is a standard first-line antiretroviral therapy for human immunodeficiency virus (HIV).
- Hepatotoxicity is a known, though uncommon, adverse effect associated with antiretroviral drugs, particularly efavirenz.
Observation:
- A 40-year-old female with HIV initiated EFV/FTC/TDF treatment.
- Eight months post-initiation, she presented with elevated liver enzymes (transaminitis) and right upper quadrant pain.
- Other causes, including viral hepatitis and substance abuse, were ruled out.
Findings:
- Discontinuation of EFV/FTC/TDF led to the resolution of transaminitis and abdominal pain.
- This case represents the first documented instance of hepatotoxicity attributed to the specific combination of EFV/FTC/TDF.
- Efavirenz-induced hepatotoxicity is hypothesized to involve autophagy, a cellular self-degradation process.
Implications:
- This report expands the understanding of potential adverse drug reactions associated with EFV/FTC/TDF.
- Clinicians should consider EFV/FTC/TDF-induced hepatotoxicity in patients presenting with unexplained liver enzyme elevations.
- Further research may be warranted to elucidate the mechanisms and incidence of this rare adverse event.
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