Fink Douglas L, Bloch Edward
Royal Free London NHS Foundation Trust, HIV Services, London, UK.
Int J STD AIDS. 2013 Oct;24(10):831-3. doi: 10.1177/0956462413483720. Epub 2013 Jul 19.
We present the first case report in the UK of acute liver failure caused by efavirenz therapy culminating in liver transplantation. A 26-year-old Zimbabwean woman commenced emtricitabine, tenofovir and efavirenz (Atripla) in December 2011. Her liver function tests at baseline and at 20 days after initiating antiretroviral therapy were normal. At three months of therapy her blood tests haemolysed and were not processed. She had previously missed follow-up appointments and on this occasion failed to return for repeat tests. She was not seen again until after six months of antiretroviral therapy when she presented to her general practitioner with acute liver failure. Her condition deteriorated and she required liver transplantation. She recovered well and re-started antiretroviral therapy to good effect. The case illustrates the value of routine monitoring after initiating antiretroviral therapy and the fundamental importance of engaging patients in long-term management to ensure safe treatment.
我们报告了英国首例由依法韦仑治疗导致急性肝衰竭并最终进行肝移植的病例。一名26岁的津巴布韦女性于2011年12月开始服用恩曲他滨、替诺福韦和依法韦仑（Atripla）。其基线肝功能检查以及开始抗逆转录病毒治疗20天后的检查均正常。治疗三个月时，她的血液检测样本溶血，未能进行检测。她之前错过随访预约，此次也未返回进行复查。直到抗逆转录病毒治疗六个月后，她因急性肝衰竭就诊于全科医生，才再次被发现。她的病情恶化，需要进行肝移植。她恢复良好，并重新开始抗逆转录病毒治疗，效果良好。该病例说明了启动抗逆转录病毒治疗后进行常规监测的价值，以及让患者参与长期管理以确保安全治疗至关重要。
