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CC BY-NC-ND 4.0 · Z Gastroenterol 2024; 62(03): 404-406
DOI: 10.1055/a-2079-6445
Kasuistik

Preexposition Prophylaxis With Truvada (Tenofovir/Emtricitabine) as Potential Cause of Celiac Disease-Like Enteropathy

Präexpositionsprophylaxe mit Truvada (Tenofovir/Emtricitabin) als eine mögliche Ursache Zöliakie-ähnlicher Enteropathie
Jagoda Pokryszka 
1   Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria (Ringgold ID: RIN27271)
2   Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria (Ringgold ID: RIN155700)
,
Martina Wichlas
3   Gruppenpraxis Interne Donaustadt, Vienna, Austria
,
Harald Vogelsang
1   Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria (Ringgold ID: RIN27271)
,
Michael Trauner
1   Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria (Ringgold ID: RIN27271)
,
Merima Herac-Kornauth‡
4   Clinical Institute of Pathology, Medical University of Vienna, Wien, Austria (Ringgold ID: RIN27271)
,
Lili Kazemi-Shirazi‡
1   Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria (Ringgold ID: RIN27271)
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Abstract

We present here a case of a 39-year-old patient who presented with celiac-disease-like symptoms and MARSH 3a histology in duodenal biopsies under normal diet. Interestingly, HLA genotyping and celiac-specific serology were negative, primarily leading to exclusion of celiac disease. However, biopsies from a second endoscopy a couple of months later (still under normal diet) showed histologic progression of the disease to MARSH 3b and led to the re-evaluation of the out-of-hospital-obtained histological samples by a pathologist experienced in celiac disease. The second biopsy described previously as MARSH 3b turned out to be non-specific and was therefore re-classified as MARSH 0. After all known causes of duodenal villous atrophy were excluded by a thorough evaluation, a correlation between the first biopsy (MARSH 3a) and Truvada intake could be established. After Truvada discontinuation and under normal diet, normalisation of duodenal mucosa was observed, leading to the assumption that Truvada could lead to celiac-like enteropathy.

Zusammenfassung

Wir präsentieren den Fall eines 39-jährigen Patienten, der unsere Klinik aufgrund von Zöliakie-ähnlichen Symptomen und einem histologischen Befund von MARSH 3a aufgesucht hat. Die Zöliakie-spezifische Serologie sowie HLA-Genotypisierung waren jedoch negativ, wodurch Zöliakie ausgeschlossen wurde. Sechs Monate später wurden erneut intestinale Biopsien entnommen, die die Progression der Erkrankung von MARSH 3a auf MARSH 3b zeigten. Infolgedessen wurden die histologischen Schnitte noch einmal, von einem in Zöliakie erfahrenen Pathologen befundet. Die zweite Biopsie – ursprünglich MARSH 3b – stellte sich als unspezifisch heraus und wurde auf MARSH 0 heruntergestuft. Wir konnten alle bekannten Ursachen von Zottenatrophie ausschließen und letzlich eine Korrelation zwischen der ersten Biopsie (MARSH 3a) und Einnahme von Truvada feststellen. Nachdem der Patient das Medikament abgesetzt und dabei eine normale Diät gehalten hatte, normalisierte sich die duodenale Mucosa, was zur Annahme führte, dass Truvada eine Zöliakie-ähnliche Enteropathie verursachen kann.

Keywords

celiac disease - Truvada - villous atrophy - MARSH

Schlüsselwörter

Zöliakie - Truvada - Zottenatrophie - MARSH


Publikationsverlauf

Eingereicht: 10. Januar 2023

Artikel online veröffentlicht:
15. Mai 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Grulich AE, Guy R, Amin J. et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 2018; 5 (11) e629-e637
    CrossrefPubMedGoogle Scholar
  • 2 Catassi C, Verdu EF, Bai JC. et al. Coeliac disease. Lancet (London, England) 2022; 399 (1034) 2413-2426
    CrossrefPubMedGoogle Scholar
  • 3 Vogelsang H, Genser D, Wyatt J. et al. Screening for celiac disease: a prospective study on the value of noninvasive tests. The American journal of gastroenterology 1995; 90 (03) 394-398 (PMID: 7872276)
    PubMedGoogle Scholar
  • 4 Vogelsang H, Wyatt J, Penner E. et al. Screening for celiac disease in first-degree relatives of patients with celiac disease by lactulose/mannitol test. The American journal of gastroenterology 1995; 90 (10) 1838-1842
    PubMedGoogle Scholar
  • 5 Al-Toma A, Volta U, Auricchio R. et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019; 7 (05) 583-613 DOI: 10.1177/2050640619844125. (PMID: 31210940)
    CrossrefPubMedGoogle Scholar
  • 6 Taavela J, Koskinen O, Huhtala H. et al. Validation of morphometric analyses of small-intestinal biopsy readouts in celiac disease. PloS one 2013; 8 (10) e76163 DOI: 10.1371/journal.pone.0076163. (PMID: 24146832)
    CrossrefPubMedGoogle Scholar
  • 7 Chou R, Evans C, Hoverman A. et al. Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force. Jama 2019; 321 (22) 2214-2230 DOI: 10.1001/jama.2019.2591. (PMID: 31184746)
    CrossrefPubMedGoogle Scholar
  • 8 Hammer SM. Nucleoside analogue reverse transcriptase inhibitor options: a re-examination of the class. Top HIV Med 2006; 14 (04) 140-143 (PMID: 17114828)
    PubMedGoogle Scholar
  • 9 Kohler JJ, Hosseini SH, Hoying-Brandt A. et al. Tenofovir renal toxicity targets mitochondria of renal proximal tubules. Lab Invest 2009; 89 (05) 513-519 DOI: 10.1038/labinvest.2009.14. (PMID: 19274046)
    CrossrefPubMedGoogle Scholar
  • 10 Bañó M, Morén C, Barroso S. et al. Mitochondrial Toxicogenomics for Antiretroviral Management: HIV Post-exposure Prophylaxis in Uninfected Patients. Front Genet 2020; 11: 497 DOI: 10.3389/fgene.2020.00497. (PMID: 32528527)
    CrossrefPubMedGoogle Scholar
  • 11 Lozier MR, Sanchez AM, Reyes R. Eosinophilic Colitis Associated with Emtricitabine/Tenofovir. Cureus 2018; 10 (10) e3498 DOI: 10.7759/cureus.3498. (PMID: 30648039)
    CrossrefPubMedGoogle Scholar
  • 12 Tran TH, Li H. Olmesartan and drug-induced enteropathy. P t 2014; 39 (01) 47-50 (PMID: 24672214)
    PubMedGoogle Scholar