Fatal lactic acidosis in hepatitis B virus-associated decompensated cirrhosis treated with tenofovir

Abstract

Rationale:Recently tenofovir disoproxil fumarate (TDF) has been widely used as a first-line therapy for chronic hepatitis B (CHB) infection. Although TDF demonstrates successful viral suppression, the possibility of renal failure and lactic acidosis has been proposed with TDF administration, especially in human immunodeficiency virus co-infected patients. However, TDF induced lactic acidosis has never been reported in CHB mono-infected patients.Patient concerns:A 59-year-old man received TDF for hepatitis B associated with cirrhosis. After ten days of TDF administration, nausea, vomiting and abdominal pain developed. High anion gap acidosis with elevated lactate level (pH 7.341, pCO2 29.7 mmHg, HCO3- 15.6mmHg, lactate 3.2mmol/L, anion gap 15.4 mEq/L) was developed.Diagnosis:With no infection, normal diagnostic paracentesis, and urinalysis together with high anion gap and increased blood lactate levels suggested lactic acidosis.Interventions:TDF was stopped, and haemodialysis was performed to control lactic acidosis.Outcomes:Although stopping TDF instantly and treating lactic acidosis using hemodialysis, the patient died.Lessons:Although, Fatal lactic acidosis is very rare in TDF patient, however, decompensated cirrhotic patients should be closely observed to keep the possibility of lactic acidosis in mind.

Tenofovir alafenamide associated fatal lactic acidosis in an autologous hematopoietic stem cell transplant recipient

“…We also found a single case report of a patient infected with HCV & HIV on tenofovir, emtricitabine, and efavirenz developing fatal lactic acidosis . Last, there currently is a single case report in the literature of fatal lactic acidosis in a patient with chronic HBV treated with single‐drug agent TDF . Our case is the first case of a fatal lactic acidosis probably developing from treatment with single NA agent (TAF) in a HSCT recipient with history of HBV and no HIV disease.…”

Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide

“…Additionally, concerns for permanent renal damage were suggested in patients taking highly active antiretroviral therapy (HAART) in this study published in 2009 [ 18 ]. Important to note, since 2003, several cases of fatal or severe lactic acidosis have been implicated with the use of TDF isolated [ 21 - 23 ] or in association especially with didanosine [ 9 , 24 ]. In addition, different associations including TDF and stavudine [ 5 , 24 ] as well as emtricitabine were also involved in episodes of lactic acidosis [ 25 - 27 ].…”

“…It is suggested that underlying conditions and combinations of drugs can precipitate lactic acidosis. This includes liver cirrhosis [ 21 ], coinfection with hepatitis C and B [ 21 , 23 , 26 ], diabetes mellitus [ 21 , 22 , 25 ], chronic kidney disease [ 11 ] and concurrent metformin use [ 24 ]. However, in 2012, Qayyum et al reported a case of acute liver failure and severe lactic acidosis with TDF/FTC and efavirenz after three months of initiation of treatment in a 41-year-old male without previous liver disease [ 27 ].…”

Advanced Therapeutics, Vaccinations, and Precision Medicine in the Treatment and Management of Chronic Hepatitis B Viral Infections; Where Are We and Where Are We Going?

“…Accordingly, LMV and LdT treatment are nowadays not preferred due in part to their weak antiviral potencies and the high frequencies with which drug resistance develops. In addition, cases of mitochondrial toxicity have emerged, with LMV or LdT treatment, that are generally observed as myopathies, neuropathies, or lactic acidoses [24], although the incidence of LMV-induced lactic acidosis during treatment is rare [25].…”

“…Once again, the known modifying impact of HBV genotypes on NUC treatment outcomes are summarized (Table 2). Furthermore, there are clear indications that even when treated with the second generation NUCs, such as ETV and TDF, patients with highly impaired liver functions can develop lactic acidosis [25,36]. Currently, the clinical relevance of TAF treatment is yet to be fully established and further studies are required to follow up the long-term use of this prodrug [37].…”