Successful Treatment of Mitochondrial Toxicity in an HIV-Positive Patient After Liver Transplantation

• Pharmacologic management of HAART and immunosuppressive therapy in HIV+ liver transplant recipients is presented.
• Diagnosis and recognition of mitochondrial toxicity, a potentially fatal consequence of NRTIs, is examined.
• Management and treatment of mitochondrial toxicity in a HIV liver transplant recipient is discussed.

Liver transplantation in patients infected with the human immunodeficiency virus (HIV) has been increasingly performed with reasonable outcomes; however, medical management of both immunosuppression and antiretroviral therapy can be challenging owing to drug toxicities and interactions. Nucleoside reverse transcriptase inhibitors (NRTIs), a common backbone of highly active antiretroviral therapy (HAART), were the first class of effective antiretroviral drugs developed. NRTIs are commonly used for posttransplant HAART therapy and have a rare but fatal complication of mitochondrial toxicity, manifesting as severe lactic acidosis, hepatic steatosis, and lipoatrophy. Herein, we have reported on the first known successful treatment of severe mitochondrial toxicity secondary to NRTIs in an HIV-infected transplant recipient.