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A case of rilpivirine drug-induced liver injury

Liver toxicity is a frequent adverse event following antiretroviral therapy for HIV, ranging from asymptomatic increases in liver enzymes to fulminant liver failure.1 2 Rilpivirine is a second-generation non-nucleoside reverse transcriptase inhibitor with low rates of liver enzyme elevations.3 We report a case of acute hepatitis secondary to rilpivirine with histological documentation.

A 27-year-old Mediterranean man was diagnosed with HIV, with a baseline CD4 count of 0.359 ×109/L and an HIV-1 viral load of 21 525 copies/mL. His last negative HIV test was 2 years prior. His medical history included depression, G6PD deficiency and a beta thalassaemia carrier status. He reported minimal alcohol intake. His baseline liver markers were normal.

Abacavir/lamivudine 600/300 mg once daily and raltegravir 400 mg two times per day were started on week 4 following diagnosis. Raltegravir was switched to rilpivirine 25 mg once …