title: Acute liver failure associated with antiretroviral treatment for HIV: a report of six cases.
abstract: OBJECTIVE
  Severe hepatotoxicity is a rare but potentially fatal side effect of all antiretrovirals. We report a series of six human immunodeficiency virus (HIV)-infected patients admitted with acute liver failure (ALF) over a 25-month period, of whom five died. All had been treated with a range of antiretroviral therapy and only two had had acquired immune deficiency syndrome (AIDS) defining illnesses.
  
  
  RESULTS
  Median duration of antiretroviral therapy was 12.5 months (range 1-23). Median time from the introduction of new antiretroviral therapy to the onset of ALF was 8 weeks (range 2-12). The development of ALF was unrelated to duration of HIV treatment or type of antiretroviral therapy, and was not predicted by close out-patient supervision and monitoring of liver function. Biochemical investigations were variable but revealed a predominantly hepatocellular pattern. Liver biopsy revealed typical features of mitochondrial toxicity in only one case, with confluent hepatocellular necrosis, inflammation and cholestasis seen in the others.
  
  
  CONCLUSIONS
  There is a need to increase awareness of the potential hepatotoxicity of antiretroviral therapy and to develop means of predicting its development. With increasing usage of antiretroviral therapy, severe hepatotoxicity and ALF may arise more frequently, and the outcome is poor despite intensive supportive therapy.
authors.affiliation: Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Sarah
authors.initials: S
authors.lastname: Creighton
authors.forename: Bernard
authors.initials: B
authors.lastname: Portmann
authors.forename: Christopher
authors.initials: C
authors.lastname: Taylor
authors.forename: Julia A
authors.initials: JA
authors.lastname: Wendon
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cramp
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged