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

Transpl Infect Dis. 2018 Oct;20(5):e12960. doi: 10.1111/tid.12960. Epub 2018 Jul 18.


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.

Keywords: antiviral therapy; lactic acidosis; transplantation.

Publication types

  • Case Reports

MeSH terms

  • Acidosis, Lactic / chemically induced*
  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Aged
  • Alanine
  • Antiviral Agents / adverse effects*
  • Fatal Outcome
  • HIV Infections / drug therapy
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hepatitis B / drug therapy
  • Hepatitis C / drug therapy
  • Humans
  • Male
  • Multiple Myeloma / surgery
  • Tenofovir / analogs & derivatives
  • Transplantation, Autologous / adverse effects


  • Antiviral Agents
  • Tenofovir
  • tenofovir alafenamide
  • Adenine
  • Alanine