Advertisement

Infection

, Volume 47, Issue 1, pp 115–119 | Cite as

Overdose of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in an HIV-1-infected subject with attempted suicide

  • Hortensia ÁlvarezEmail author
  • Ana Mariño
  • Nieves Valcarce
  • Jesús García-González
  • Helena Díaz-Cambre
  • Josep M. Llibre
Case Report
  • 111 Downloads

Abstract

Introduction

Data are lacking regarding overdose of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (E/C/F/TAF).

Material and methods

We present the first report of suicidal attempt with E/C/F/TAF in a Human Immunodeficiency Virus-infected subject.

Results

A reversible acute renal failure with no proximal tubulopathy and neuropsychiatric issues are discussed. E/C/F/TAF withdrawal resulted in favourable renal and neuropsychiatric outcomes. The suicide attempt seemed unrelated to the integrase strand transfer inhibitor, being evenly explained within the context of stressful personal conflicts.

Conclusion

A suicidal attempt with an E/C/F/TAF overdose in an HIV-infected patient, resulted in a favourable outcome from a renal and neuropsychiatric standpoint.

Keywords

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide Overdose Suicide attempt 

Notes

Compliance with ethical standards

Conflict of interest

Hortensia Álvarez has received support for attending meetings from Janssen-Cilag, Gilead Sciences, ViiV Healthcare, AbbVie, and Merck Sharp and Dohme. Ana Mariño has received support for attending meetings from Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag and ViiV Healthcare. Josep M. Llibre has received grants from ViiV Healthcare and has received honoraria and consulting fees from Gilead Sciences, Merck Sharp and Dohme, Bristol-Myers Squibb, and ViiV Healthcare, all them outside the submitted work. The remaining authors declare no relevant conflicts of interest to the content of the manuscript.

Human rights statement

This is a research involving a human participant. The patient provided written consent for publication of his clinical record.

References

  1. 1.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/ AdultandAdolescentGL.pdf. Accessed June 7, 2018
  2. 2.
    European AIDS Clinical Society. European guidelines for clinical management and treatment of HIV-1-infected adults in Europe, version 9.0. Available at http://www.eacsociety.org/files/guidelines_9.0-english.pdf. Accessed August 17, 2018.
  3. 3.
    de Boer MG, van der Berk GE, van Holten N, Oryszcyn JE, Dorama W, Moha DA, et al. Intolerance of dolutegravir-containing combination antiretroviral therapy regimens in real-life clinical practice. AIDS. 2016;30:2831–4.CrossRefGoogle Scholar
  4. 4.
    Llibre JM, Esteve A, Miro JM, Mateo G, Curran A, Podzamczer D, Riera M. Discontinuation of DTG, EVG/c and RAL due to toxicity in a prospective cohort. In: Presented at 24rd annual conference on retroviruses and opportunistic infections (CROI); February 13–16 2017, Seattle, Washington, USA. Abstract P651.Google Scholar
  5. 5.
    Lee M, Eyer F, Felgenhauer N, Klinker H, Spinner C. Overdose of dolutegravir in combination with tenofovir disoproxil fumarate/emtricitabine in suicide attempt in a 21-year old patient. AIDS Res Ther. 2015;12:18.CrossRefGoogle Scholar
  6. 6.
    Callebaut C, Stepan G, Tian Y, Miller MD. In vitro virology profile of tenofovir alafenamide, a novel oral prodrug of tenofovir with improved antiviral activity compared to that of tenofovir disoproxil fumarate. Antimicrob Agents Chemother. 2015;59:5909–16.CrossRefGoogle Scholar
  7. 7.
    Yombi JC, Pozniak A, Boffito M, Jones R, Khoo S, Levy J, Post FA. Antiretrovirals and the kidney in current clinical practice: renal pharmacokinetics, alterations of renal function and renal toxicity. AIDS. 2014;28:621–32.CrossRefGoogle Scholar
  8. 8.
    Mills A, Arribas JR, Andrade-Villanueva J, DiPerri G, Van Lunzen J, Koenig E, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in antiretroviral regimens for virologically suppressed adults with HIV-1 infection: a randomised, active-controlled, multicenter, open-label, phase 3, non-inferiority study. Lancet Infect Dis. 2016;16:43–52.CrossRefGoogle Scholar
  9. 9.
    Post FA, Tebas P, Clarke A, Cotte L, Short WR, Abram ME, et al. Brief report: switching to tenofovir alafenamide, coformulated with elvitegravir, cobicistat and emtricitabine, in HIV-infected adults with renal impairment: 96-week results from a single-arm multicenter, open-label phase 3 study. J Acquir Immune Defic Syndr. 2017;74:180–4.CrossRefGoogle Scholar
  10. 10.
    Gupta SK, Post FA, Arribas JR, Pozniak A, Podzamczer D, Clarke A, et al. Renal safety of TAF vs TDF or ABC in a pooled analysis of 27 phase 2/3 clinical trials. In: Presented at: 22nd international AIDS conference; July 23–27 2018, Amsterdam, The Netherlands. Abstract TUPEB113.Google Scholar
  11. 11.
    Arribas JR, Thompson M, Sax PE, Haas B, McDonald C, Wohl DA, et al. Brief report: randomized, double-blind comparison of tenofovir alafenamide (TAF) vs tenofovir disoproxil fumarate (TDF), each coformulated with elvitegravir, cobicistat, and emtricitabine (E/C/F) for initial HIV-1 treatment: week 144 results. J Acquir Immune Defic Syndr. 2017;75:211–8.CrossRefGoogle Scholar
  12. 12.
    Gaur AH, Kizito H, Prasitsueubsai W, Rakhmanina N, Rassool M, Chakraborty R, et al. Safety, efficacy, and pharmacokinetics of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in treatment-naive, HIV-infected adolescents: a single-arm, open-label trial. Lancet HIV. 2016;3:e561–8.CrossRefGoogle Scholar
  13. 13.
    Huhn GD, Tebas P, Gallant J, Wilkin T, Cheng A, Yan M, et al. A randomized, open-label trial to evaluate switching to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide plus darunavir in treatment-experienced HIV-1-infected adults. J Acquir Immune Defic Syndr. 2017;74:193–200.CrossRefGoogle Scholar
  14. 14.
    Gallant J, Brunetta J, Crofoot G, Benson P, Mills A, Brinson C, et al. Brief report: efficacy and safety of switching to a single-tablet regimen of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in HIV-1/hepatitis B-coinfected adults. J Acquir Immune Defic Syndr. 2016;73:294–8.CrossRefGoogle Scholar
  15. 15.
    Hodder S, Squires K, Kityo C, Hagins D, Avihingsanon A, Plotnikova Y, et al. Efficacy and safety of switching to E/C/F/TAF in virologically suppressed women. In: Presented at: 24rd annual conference on retroviruses and opportunistic infections (CROI); February 13–16 2017, Seattle, Washington, USA. Abstract P443.Google Scholar
  16. 16.
    GENVOYA Elvitegravir. cobicistat, emtricitabine, and tenofovir alafenamide. Tablet. Food and Drug Administration. Available from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207561s002lbl.pdf. Accessed on May 13, 2018.
  17. 17.
    Eron JJ, Lelievre J-D, Kalayjian R, Slim J, Wurapa AK, Stephens JL, et al. Safety and efficacy of E/C/F/TAF in HIV-infected adults on chronic hemodialysis. In: Presented at: 25th annual conference on retroviruses and opportunistic infections (CROI; March 4–7 2018, Boston, MA. Abstract P732.Google Scholar
  18. 18.
    ISENTRESS Raltegravir. Film-coated tablets. Food and Drug Administration. Available from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/022145s038,205786s007,0203045s015lbl.pdf. Accessed on May 13, 2018.
  19. 19.
    TIVICAY Dolutegravir. Tablet Food and Drug Administration. Available from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/204790s007lbl.pdf. Accessed on May 13, 2018.
  20. 20.
    BIKTARVY Bictegravir emtricitabine, and tenofovir alafenamide. Tablet Food and Drug Administration. Available from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210251s000lbl.pdf. Accessed on July 3, 2018.
  21. 21.
    Hoffmann C, Welz T, Sabranski M, Kolb M, Wolf E, Stellbrink HJ, et al. Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients. HIV Med. 2017;18:56–63.CrossRefGoogle Scholar
  22. 22.
    Wohl DA, Cohen C, Gallant JE, Mills A, Sax PE, Dejesus E, et al. A randomized, double-blind comparison of single-tablet regimen elvitegravir/cobicistat/emtricitabine/tenofovir DF versus single-tablet regimen efavirenz/emtricitabine/tenofovir DF for initial treatment of HIV-1 infection: analysis of week 144 results. J Acquir Immune Defic Syndr. 2014;65:e118–20.CrossRefGoogle Scholar
  23. 23.
    Pozniak A, Flamm J, Antinori A, Bloch M, Ward D, Berenguer J, et al. Switching to the single-tablet regimen of elvitegravir, cobicistat, emtricitabine, and tenofovir DF from non-nucleoside reverse transcriptase inhibitor plus coformulated emtricitabine and tenofovir DF regimens: Week 96 results of STRATEGY-NNRTI. HIV Clin Trials. 2017;18:141–8.CrossRefGoogle Scholar
  24. 24.
    Arribas JR, DeJesus E, van Lunzen J, Zurawski C, Doroana M, Towner W, et al. Simplification to single-tablet regimen of elvitegravir, cobicistat, emtricitabine, tenofovir DF from multi-tablet ritonavir-boosted protease inhibitor plus coformulated emtricitabine and tenofovir DF regimens: week 96 results of STRATEGY-PI. HIV Clin Trials. 2017;18:118–25.CrossRefGoogle Scholar
  25. 25.
    Viswanathan P, Baro E, Soon G, Sherwat A, Struble K. Neuropsychiatric adverse events associated with integrase strand transfer inhibitors. In: Presented at: 24rd annual conference on retroviruses and opportunistic infections (CROI); February 13–16 2017, Seattle, Washington, USA. Abstract P372.Google Scholar
  26. 26.
    Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for suicide ideation. J Consult Clin Psychol. 1979;47:343–52.CrossRefGoogle Scholar
  27. 27.
    Beck AT, Schuyler D, Herman I. Development of suicidal intent scales. In: Beck AT, Resnick HLP, Lettieri DJ, editors. The prediction of suicide. Bowie: Charles Press; 1974. p. 45–56.Google Scholar
  28. 28.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hortensia Álvarez
    • 1
    Email author
  • Ana Mariño
    • 1
  • Nieves Valcarce
    • 2
  • Jesús García-González
    • 3
  • Helena Díaz-Cambre
    • 4
  • Josep M. Llibre
    • 5
  1. 1.Infectious Diseases Unit, Internal Medicine DepartmentUniversity Hospital of FerrolFerrol, A CoruñaSpain
  2. 2.Hospital PharmacyUniversity Hospital of FerrolA CoruñaSpain
  3. 3.Psychiatry DepartmentUniversity Hospital of FerrolA CoruñaSpain
  4. 4.Nephrology DepartmentUniversity Hospital of FerrolA CoruñaSpain
  5. 5.Infectious Diseases and “Fight AIDS” FoundationUniversity Hospital Germans Trias i PujolBarcelonaSpain

Personalised recommendations