Fatal Hepatic Failure in a Hemophilia A Patient with HIV/HCV Co-infection

Abstract

Objective: In Japan, most people who have infection with HIV also have infection with HCV caused by administration of coagulation factor products. Fatal lactic acidosisrarely occurs in patients with HIV/HCV co-infection while using both HAART drugs and rivabirin. We experienced a patient with fatal hepatic failure following lactic acidosis after the use of both HAART drugs and rivabirin. We report this rare case with discussion of the results of postmortem examination.
Case Report: A 35-year-old man infected with HIV and HCV after administration of blood products for hemophilia A was started on anti-retroviral therapy for HIV in 1990. He was treated with d4T+ddI+PI (RTV+LPV) from January 2003 after several changes of anti-retroviral drugs. From September 2003, IFNα and ribavirin were also administered for treatment of HCV hepatitis. Symptoms of lactic acidosis initially appeared in October. Although the above-described medication was stopped and treatment for lactic acidosis, including intravenous administration of sodium bicarbonate, was started immediately, hepatic insufficiency rapidly progressed and he died in November 2003.
Conclusion: In this case, rapidly progressing hepatic insufficiency was induced bylactic acidosis. We concluded that hepatic failure was possibly caused by lactic acidosis, side effects of combined therapy with IFNα and ribavirin, and rapid progression to non-compensative liver cirrhosis from HCV hepatitis.