Background: Acute liver failure (ALF) due to antiretroviral treatment is a rare but a fatal complication in HIV-infected patients. Non-nucleoside retroviral transcriptase inhibitors are known to cause hepatotoxicity and exceptionally acute hepatic failure.
Case Report: We report a case of nevirapine-induced acute liver failure successfully managed with orthotopic liver transplantation (OLT). Antiretroviral therapy including raltegravir, zidovudine and abacavir was reintroduced 6 days after transplantation. No interaction with immunosuppressive agents was observed and the patient had a complete recovery.
Conclusions: Urgent OLT should be considered in HIV patients with nevirapine-induced ALF because of the poor outcome despite intensive supportive conservative treatment. Concomitant use of highly active antiretroviral therapy (HAART) and immunosuppression could be feasible if treatment is performed cautiously.

Keywords: nevirapine hepatotoxicity, urgent liver transplantation, acute liver failure, antiretroviral drugs, Immunosuppressive Agents