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Juan Carlos Lopez-Delgado, Rafael Mañez Mendiluce, Teresa Serrano Pinol, Xose Pérez Fernández, Laura Sanchez, Rosa Granada Vicente
Ann Transplant 2012; 17(1): 122-127
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.
Case Report: 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.