Tenofovir alafenamide associated fatal lactic acidosis in an autologous hematopoietic stem cell transplant recipient

• Published in: Transplant infectious disease Vol. 20; no. 5; pp. e12960 - n/a
• Main Authors: Alsunaid, Sammar R., Ashraf, Humayun, Soubani, Ayman O.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.10.2018
• Subjects: Acidosis; Acidosis, Lactic - chemically induced; Adenine - adverse effects; Adenine - analogs & derivatives; Aged; Antiretroviral drugs; Antiviral Agents - adverse effects; antiviral therapy; Autografts; Fatal Outcome; Fatalities; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Hepatitis; Hepatitis B; Hepatitis B - drug therapy; Hepatitis C - drug therapy; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Lactic acidosis; Male; Multiple myeloma; Multiple Myeloma - surgery; Nucleoside analogs; Nucleotide analogs; Stem cell transplantation; Stem cells; Tenofovir; Transplantation; Transplantation, Autologous - adverse effects; Transplants & implants; lactic acidosis; antiviral therapy; transplantation
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12960

Fatal lactic acidosis has been reported while on the treatment with Nucleoside/nucleotide analogues (NA) for the treatment of hepatitis B, C and HIV. No cases of such a complication have been reported in hematopoietic stem cell transplant (HSCT) recipients. We present a 65‐year male who underwent autologous HSCT for the treatment of multiple myeloma. Prior to transplant he was started on single agent tenofovir alafenamide (TAF) for treatment of resolved hepatitis B infection. He presented few weeks later with severe lactic acidosis. Other causes of lactic acidosis were excluded. The patient died of multi‐organ failure despite stopping TAF and aggressive supportive care. The case demonstrates the need for increased awareness of this potential complication of NA treatment in the course of transplantation.