title: Urgent liver transplantation for nevirapine-induced acute liver failure: report of a case and review of the literature.
abstract: BACKGROUND
  Acute liver failure (ALF) due to antiretroviral treatment is a rare but a fatal complication in HIV-infected patients. Non-nucleoside retroviral transcriptase inhibitors are known to cause hepatotoxicity and exceptionally acute hepatic failure.
  
  
  METHODS
  We report a case of nevirapine-induced acute liver failure successfully managed with orthotopic liver transplantation (OLT). Antiretroviral therapy including raltegravir, zidovudine and abacavir was reintroduced 6 days after transplantation. No interaction with immunosuppressive agents was observed and the patient had a complete recovery.
  
  
  CONCLUSIONS
  Urgent OLT should be considered in HIV patients with nevirapine-induced ALF because of the poor outcome despite intensive supportive conservative treatment. Concomitant use of highly active antiretroviral therapy (HAART) and immunosuppression could be feasible if treatment is performed cautiously.
authors.affiliation: Department of Intensive Care, Hospital Universitari de Bellvitge, Barcelona, Spain. juancarloslopezde@hotmail.com
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Lopez-Delgado
authors.forename: Rafael Mañez
authors.initials: RM
authors.lastname: Mendiluce
authors.forename: Teresa Serrano
authors.initials: TS
authors.lastname: Pinol
authors.forename: Xose Pérez
authors.initials: XP
authors.lastname: Fernández
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchez
authors.forename: Rosa Granada
authors.initials: RG
authors.lastname: Vicente
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000601:surgery*; D016031:Liver Transplantation; D019829:Nevirapine / Q000009:adverse effects*
chemical_list: D019380:Anti-HIV Agents; D007166:Immunosuppressive Agents; D019829:Nevirapine