Skip to main content

Advertisement

SpringerLink
Log in

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

  • Case Report
  • Published:
Infection Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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. 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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

  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. 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.

  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. 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. 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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

  26. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for suicide ideation. J Consult Clin Psychol. 1979;47:343–52.

    Article  CAS  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, Avda. da Residencia, s/n, 15405, Ferrol, A Coruña, Spain

    Hortensia Álvarez & Ana Mariño

  2. Hospital Pharmacy, University Hospital of Ferrol, A Coruña, Spain

    Nieves Valcarce

  3. Psychiatry Department, University Hospital of Ferrol, A Coruña, Spain

    Jesús García-González

  4. Nephrology Department, University Hospital of Ferrol, A Coruña, Spain

    Helena Díaz-Cambre

  5. Infectious Diseases and “Fight AIDS” Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

    Josep M. Llibre

Authors
  1. Hortensia Álvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Mariño
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nieves Valcarce
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jesús García-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helena Díaz-Cambre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Josep M. Llibre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hortensia Álvarez.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Álvarez, H., Mariño, A., Valcarce, N. et al. Overdose of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in an HIV-1-infected subject with attempted suicide. Infection 47, 115–119 (2019). https://doi.org/10.1007/s15010-018-1201-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1201-x

Keywords

Search

Navigation