Efavirenz intoxication due to slow hepatic metabolism.
We describe a human immunodeficiency virus-positive woman who presented with severe psychosis while she was receiving therapy with efavirenz. Her plasma efavirenz level was excessively high. Genetic investigation showed that she was homozygous for the CYP2B6 G516T allele, resulting in slow hepatic metabolism. After the dosage of efavirenz was lowered, all neuropsychiatric symptoms subsided.
Hasse
B
B
Department of Internal Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland. barbara.hasse@stgag.ch
Günthard
H F
HF
Bleiber
G
G
Krause
M
M
D000328:Adult; D000480:Alkynes; D000483:Alleles; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000097:blood / Q000378:metabolism; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D048588:Benzoxazines; D003521:Cyclopropanes; D065702:Cytochrome P-450 CYP2B6; D004305:Dose-Response Relationship, Drug; D005260:Female; D020022:Genetic Predisposition to Disease; D015658:HIV Infections / Q000188:drug therapy; D006720:Homozygote; D006801:Humans; D008099:Liver / Q000201:enzymology; D010078:Oxazines / Q000009:adverse effects* / Q000097:blood / Q000378:metabolism*; D010089:Oxidoreductases, N-Demethylating / Q000235:genetics; D011605:Psychoses, Substance-Induced / Q000175:diagnosis*
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D010078:Oxazines; D001189:Aryl Hydrocarbon Hydroxylases; C585599:CYP2B6 protein, human; D065702:Cytochrome P-450 CYP2B6; D010089:Oxidoreductases, N-Demethylating; C098320:efavirenz