Lactate serum concentrations during treatment with nucleos(t)ide analogues in hepatitis B with or without cirrhosis

Triantos, Christos; Kalafateli, Maria; Αγγελετοπούλου, Ιωάννα; Mandellou, Martha; Assimakopoulos, Stelios F.; Tselekouni, Paraskevi; Taprantzi, Dimitra; Tsiaoussis, Georgios I.; Vourli, Georgia; Anastassiou, Evangelos D.; Gogos, Charalambos; Labropoulou-Karatza, Chrisoula; Thomopoulos, Konstantinos

doi:10.1097/meg.0000000000000924

Cited by 1 publication

(2 citation statements)

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Section: Discussionmentioning

confidence: 94%

“…In 2015, TAF showed to be safer and better tolerated in comparison to TDF. To support this, no lactic acidosis was demonstrated by Triantos et al, who followed 107 patients with hepatitis B for five years [ 28 ]. Only in 2017, a case of acute tubular dysfunction due to mitochondrial toxicity was reported related to the use of TAF, however without severe lactic acidosis [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chaparala¹,

Silva²,

Papadopoulos³

2021

Cureus

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A 46-year-old female with a history of generalized anxiety disorder was admitted after intentional ingestion of an unknown amount of emtricitabine/tenofovir alafenamide (Descovy®) in a suicidal attempt. Patient was emergently intubated secondary to severe agitation and inability to protect airways. Patient developed severe lactic acidosis early in the admission, secondary as to a possible mitochondrial toxicity. Failed attempts to fluid resuscitation with Lactate Ringer®, eventually warranted to start the patient on norepinephrine infusion. Metabolic acidosis remained refractory to bicarbonate bolus and infusion. Hypothermia and hypoglycemia were corrected. Despite the initial approach, the patient remained acidotic, and the nephrology was consulted for emergent continuous renal replacement therapy (CRRT). After three days of intensive care unit stay and CRRT, the patient improved and was successfully decannulated. Her metabolic profile also showed remarkable improvement and the metabolic lactic acidosis resolved. The previous formulation of tenofovir with disoproxil fumarate is associated with severe lactic acidosis due to inhibition of mammalian mitochondrial DNA polymerase. Risk factors include liver cirrhosis, chronic kidney disease, hepatitis B and C coinfection, and metformin use. The new pharmaceutical formulation of tenofovir with alafenamide (TAF) has caused a significant decrease in the incidence of lactic acidosis. However, its real incidence and the usual plasma level to induce toxicity and mitochondrial dysfunction are unknown. The aim of this report is to highlight the risk of severe lactic acidosis with the use of TAF.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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

Chaparala¹,

Silva²,

Papadopoulos³

2021

Cureus

View full text Add to dashboard Cite

show abstract

Lactate serum concentrations during treatment with nucleos(t)ide analogues in hepatitis B with or without cirrhosis

Abstract: None of the patients developed lactic acidosis. There is an indication of an increasing trend of lactic acid levels up to 24 months of therapy in female cirrhotic patients.

Cited by 1 publication

References 37 publications

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

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

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