Dolutegravir-induced liver injury leading to sub-acute liver failure requiring transplantation: a case report and review of literature

Abstract

A patient with human immunodeficiency virus-1 infection presented with sub-acute liver failure, temporally related to commencement of an antiretroviral therapy regimen containing dolutegravir (Triumeq). The patient was not a carrier of HLA-B5701, and abacavir hypersensitivity was unlikely. We believe this is the first report of severe dolutegravir-related hepatotoxicity resulting in sub-acute liver failure and transplantation and highlights a potential need for closer monitoring after drug initiation.

Keywords

Antiretroviral therapy human immunodeficiency virus toxicity dolutegravir liver

Get full access to this article

View all access options for this article.

References

Guimarães Cavalcanti

Marcello de Araujo-Neto

and Mauro Peralta

Schistosomiasis: clinical management of liver disease. Clin Liv Dis 2015; 6: 59–62.

Rutherford

and Horvath

Dolutegravir plus two nucleoside reverse transcriptase inhibitors versus efavirenz plus two nucleoside reverse transcriptase inhibitors as initial antiretroviral therapy for people with HIV: a systematic review. PLoS One 2016; 11: e0162775.

Walmsley

Antela

Clumeck

et al . Dolutegravir plus Abacavir-Lamivudine for the treatment of HIV-1 infection (SINGLE study). NEJM 2013; 369: 1807–1818.

Orell

et al . Superior efficacy of dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) fixed dose combination (FDC) compared with ritonavir (RTV) boosted atazanavir (STV) plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in treatment-naïve women with HIV-1 infection (ARIA study). Presented at International AIDS Conference (IAC), 18–22 July 2016, abstract no. 10215, Durban, South Africa.

Nunez

Hepatotoxicity of antiretrovirals: incidence, mechanisms and management. J Hepatol 2006; 44: S132–S139.

Lucena

Andrade

Kaplowitz

et al . Phenotypic characterization of idiosyncratic drug-induced liver injury: the influence of age and sex. Hepatology 2009; 49: 2001–2009.

Russo

Galanko

Shrestha

et al . Liver transplantation for acute liver failure from drug induced liver injury in the United States. Liver Transpl 2004; 10: 1018–1023.

Mallal

Phillips

Carosi

et al . HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med 2008; 358: 568–579.

Monshi

Faulkner

Gibson

et al . Human leukocyte antigen (HLA)-B*57:01-restricted activation of drug-specific T cells provides the immunological basis for flucloxacillin-induced liver injury. Hepatology 2013; 57: 727–739.

10.

Sulkowski

Thomas

Chaisson

et al . Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 2000; 283: 74–80.

11.

Lee

Hynan

Rossaro

et al . Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology 2009; 137: 856–864.