Hepatic steatosis during treatment with zidovudine and lamivudine in an HIV-positive patient
Ter Hofstede, H.J.; Koopmans, P.P.; van Haelst, U.J.
Nederlands Tijdschrift Voor Geneeskunde 142(8): 415-419
1998
ISSN/ISBN: 0028-2162 PMID: 9562777 Document Number: 488325
A 33-year-old HIV-infected man was given antiretroviral therapy with zidovudine and lamivudine. After ten months' treatment the patient had elevated hepatic transaminase levels. Severe hepatic steatosis was found in the biopsy. Clinical history, laboratory, microbiologic and X-ray examination revealed no other abnormalities. The transaminase levels remained high after withdrawal of zidovudine alone, but a decrease was observed when both zidovudine and lamivudine were stopped. Rechallenge of lamivudine therapy caused the levels to increase again. The hepatic steatosis was considered to be caused by the antiretroviral therapy, lamivudine having a synergistic influence on this side effect of zidovudine. Ten months after the therapy was changed to the protease inhibitor indinavir combined with zalcitabine and stavudine, two other nucleoside analogues, hepatic steatosis recurred.