What is the significance of elevated Serum Glutamic-Pyruvic Transaminase (SGPT) to 170 and Serum Glutamic-Oxaloacetic Transaminase (SGOT) to 64 in a 30-year-old nurse who received Post-Exposure Prophylaxis (PEP) for Human Immunodeficiency Virus (HIV)?

From the Guidelines

The PEP regimen should be temporarily discontinued and the patient should be evaluated by a healthcare provider within 24-48 hours due to the elevated liver enzymes (SGPT 170, SGOT 64) suggesting medication-induced hepatotoxicity. The elevated liver enzymes in this nurse receiving HIV post-exposure prophylaxis (PEP) require immediate attention. These liver enzyme elevations suggest medication-induced hepatotoxicity, which is a known side effect of several antiretroviral medications used in PEP regimens, particularly protease inhibitors and certain nucleoside reverse transcriptase inhibitors 1. The provider should perform a comprehensive evaluation including a complete liver panel, review of other medications or substances that could affect liver function, and assessment for symptoms like jaundice, abdominal pain, or fatigue.

Key Considerations

• If PEP must be continued due to high-risk exposure, the regimen should be modified by substituting the likely offending agent with a less hepatotoxic alternative, such as replacing a protease inhibitor with an integrase inhibitor like raltegravir 1.
• Close monitoring of liver enzymes every 1-2 weeks is essential until values normalize.
• Adequate hydration and avoiding alcohol and other hepatotoxic substances are important supportive measures during this period.

Monitoring and Management

• The patient should be advised of the importance of completing the prescribed regimen and informed about potential drug interactions and side effects 1.
• The patient should be evaluated within 72 hours after exposure and monitored for drug toxicity for at least 2 weeks 1.

From the FDA Drug Label

Hepatic adverse events have been reported in patients receiving a dolutegravir-containing regimen. Patients with underlying hepatitis B or C may be at increased risk for worsening or development of transaminase elevations with use of TIVICAY or TIVICAY PD [see Adverse Reactions ( 6. 1)] . In some cases, the elevations in transaminases were consistent with immune reconstitution syndrome or hepatitis B reactivation particularly in the setting where anti-hepatitis therapy was withdrawn Cases of hepatic toxicity, including elevated serum liver biochemistries, hepatitis, and acute liver failure have been reported in patients receiving a dolutegravir-containing regimen without pre-existing hepatic disease or other identifiable risk factors.

The events were reported in less than 1% of subjects receiving TIVICAY in Phase 3 clinical trials Discontinue TIVICAY or TIVICAY PD and other suspect agents immediately if signs or symptoms of hypersensitivity reactions develop (including, but not limited to, severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters or peeling of the skin, oral blisters or lesions, conjunctivitis, facial edema, hepatitis, eosinophilia, angioedema, difficulty breathing)

The patient's elevated SGPT (170) and SGOT (64) levels may be indicative of hepatotoxicity associated with dolutegravir use, as reported in the drug label 2. It is recommended to monitor for hepatotoxicity and discontinue dolutegravir if signs or symptoms of hypersensitivity reactions, including liver injury, develop.

• Key considerations:
  • The patient's liver function should be closely monitored.
  • Dolutegravir should be discontinued if hepatotoxicity is suspected.
  • Alternative antiretroviral therapy may be necessary.

From the Research

Elevated Liver Enzymes in HIV Post-Exposure Prophylaxis

• The patient, a 30-year-old nurse, was given post-exposure prophylaxis (PEP) for HIV after being exposed to a patient with HIV, and now has elevated liver enzymes (SGPT 170, SGOT 64) 3, 4, 5, 6, 7.
• The provided studies do not directly address the issue of elevated liver enzymes in the context of HIV PEP, but rather focus on the efficacy and safety of various antiretroviral regimens, including those containing lamivudine, raltegravir, and dolutegravir.
• However, it is known that some antiretroviral medications can cause liver enzyme elevations as a side effect, and monitoring of liver function is recommended for patients taking these medications 4, 6.

Antiretroviral Regimens and Liver Enzyme Elevations

• The study by 4 found that treatment-experienced patients who switched to a regimen containing abacavir/lamivudine and raltegravir had stable liver transaminases, while 6 reported no significant alterations in liver function in treatment-naïve patients taking abacavir/lamivudine and raltegravir.
• Another study by 5 noted that the fixed-dose combination of dolutegravir, abacavir, and lamivudine is a well-tolerated and effective option for treating HIV infection, but did not specifically address liver enzyme elevations.
• A systematic literature review by 7 found that the two-drug regimen dolutegravir plus lamivudine had minimal impact on liver function and renal function in real-world clinical practice.

Conclusion Not Applicable

As per the given guidelines, a conclusion section is not applicable in this response. The information provided is based on the available studies and is intended to provide an overview of the topic.