Urgent liver transplantation for nevirapine-induced acute liver failure: report of a case and review of the literature.

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. 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. 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.