title: Efavirenz induced acute liver failure requiring liver transplantation in a slow drug metaboliser.
abstract: Highly active antiretroviral therapy has revolutionised HIV management. However, many of these drugs are potentially hepatotoxic. Here, we report the first adult case of efavirenz induced acute liver failure successfully treated by liver transplantation. Furthermore, genetic analysis revealed our patient to be a slow efavirenz metaboliser, contributing to the severity of clinical presentation.
authors.affiliation: Liver Unit, University Hospitals Birmingham, Edgbaston, Birmingham B15 2WB, United Kingdom.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elsharkawy
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schwab
authors.forename: Brendan
authors.initials: B
authors.lastname: McCarron
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Burt
authors.forename: Ann K
authors.initials: AK
authors.lastname: Daly
authors.forename: Mark
authors.initials: M
authors.lastname: Hudson
authors.forename: Steven
authors.initials: S
authors.lastname: Masson
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects*; D003521:Cyclopropanes; D065702:Cytochrome P-450 CYP2B6; D005260:Female; D020022:Genetic Predisposition to Disease; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000601:surgery; D016031:Liver Transplantation
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D001189:Aryl Hydrocarbon Hydroxylases; C585599:CYP2B6 protein, human; D065702:Cytochrome P-450 CYP2B6; C098320:efavirenz
keywords: ALF; ALP; ALT; Acute liver failure; CMV; CYP2B6; DILI; Drug induced liver injury; EFV; Efavirenz; HAART; HCV; HIV; Liver transplantation; NNRTI; NRTI; OLT; TDM; acute liver failure; alanine aminotransferase; alkaline phosphatase; cytomegalovirus; drug induced liver injury; efavirenz; hepatitis C virus; highly active antiretroviral therapy; human immunodeficiency virus; non-nucleoside reverse transcriptase inhibitor; nucleoside reverse transcriptase inhibitor; orthotopic liver transplantation; therapeutic drug monitoring