{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:36:05Z","timestamp":1784885765243,"version":"3.55.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,21]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Toxicological data on overdose with human immunodeficiency virus inhibitors are scarce. We present a case report of two independent suicide attempts by self-administered overdose with the same antiretroviral medicine Genvoya\u00ae (emtricitabine\/elvitegravir\/tenofovir alafenamide\/cobicistat). Both patients were admitted to the hospital and presented with a loss of consciousness, lactic acidosis, elevated hepatic transaminase levels and hemodynamic instability. While one patient survived with advanced supportive measures, the other passed away. Emtricitabine levels were measured in vivo in various consecutive serum samples and postmortem urine, peripheral and cardiac serum samples and confirmed excessive use in both cases. This is the first time that emtricitabine levels following overdose are reported. Although measured concentrations for emtricitabine were quite similar in these cases, metabolic acidosis was more pronounced in the fatal case. The difference in outcomes between the two could be due to a difference in physiological status, susceptibility to accumulation and adverse effects, and perhaps a varying interval between ingestion and the start of supportive measures.<\/jats:p>","DOI":"10.1093\/jat\/bkac056","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T16:57:47Z","timestamp":1659545867000},"page":"e1-e5","source":"Crossref","is-referenced-by-count":3,"title":["Overdose of the HIV Medicine Genvoya\u00ae in Two Auto-Intoxications"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0076-3185","authenticated-orcid":false,"given":"Celine","family":"Gys","sequence":"first","affiliation":[{"name":"Toxicological Center, University of Antwerp , Universiteitsplein 1, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Mortel\u00e9","sequence":"additional","affiliation":[{"name":"Laboratorium for Clinical Biology, GZA Sint-Augustinus , Oosterveldlaan 24, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babette","family":"van Rafelghem","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Antwerp University Hospital, University of Antwerp , Drie Eikenstraat 655, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Berry","sequence":"additional","affiliation":[{"name":"Toxicological Center, University of Antwerp , Universiteitsplein 1, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander L N","family":"van Nuijs","sequence":"additional","affiliation":[{"name":"Toxicological Center, University of Antwerp , Universiteitsplein 1, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Lambert","sequence":"additional","affiliation":[{"name":"Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University , Ottergemsesteenweg 460, 9000, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Antwerp University Hospital, University of Antwerp , Drie Eikenstraat 655, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Schouwers","sequence":"additional","affiliation":[{"name":"Laboratorium for Clinical Biology, GZA Sint-Augustinus , Oosterveldlaan 24, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anissa","family":"Meskal","sequence":"additional","affiliation":[{"name":"Laboratorium for Clinical Biology, GZA Sint-Augustinus , Oosterveldlaan 24, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Van Hemeldonck","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, GZA Sint-Augustinus , Oosterveldlaan 24, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Heytens","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, GZA Sint-Augustinus , Oosterveldlaan 24, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Neels","sequence":"additional","affiliation":[{"name":"Toxicological Center, University of Antwerp , Universiteitsplein 1, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Covaci","sequence":"additional","affiliation":[{"name":"Toxicological Center, University of Antwerp , Universiteitsplein 1, 2610, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,3]]},"reference":[{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1001\/jama.2020.17025","article-title":"Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel","volume":"324","author":"Saag","year":"2020","journal-title":"Journal of the American Medical Association"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"17","DOI":"10.7326\/0003-4819-135-1-200107030-00005","article-title":"Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease","volume":"135","author":"Murphy","year":"2001","journal-title":"Annals of Internal Medicine"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"D1074","DOI":"10.1093\/nar\/gkx1037","article-title":"DrugBank 5.0: a major update to the DrugBank database for 2018","volume":"46","author":"Wishart","year":"2018","journal-title":"Nucleic Acids Research"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s15010-018-1201-x","article-title":"Overdose of elvitegravir\/cobicistat\/emtricitabine\/tenofovir alafenamide in an HIV-1-infected subject with attempted suicide","volume":"47","author":"\u00c1lvarez","year":"2019","journal-title":"Infection"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-015-0054-y","article-title":"Overdose of dolutegravir in combination with tenofovir disaproxil fumarate\/emtricitabine in suicide attempt in a 21-year old patient","volume":"12","author":"Lee","year":"2015","journal-title":"AIDS Research and Therapy"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-019-1257-6","article-title":"Severe rhabdomyolysis-induced acute kidney injury following concomitant use of Genvoya\u00ae (EVG\/COBI\/FTC\/TAF) and simvastatin; a case report","volume":"20","author":"Godinho","year":"2019","journal-title":"BMC Nephrology"},{"key":"2023022112504262500_","volume-title":"Liverpool HIV Pharmacology Group","author":"HIV Drug Interactions Checker","year":"2021"},{"key":"2023022112504262500_","volume-title":"Medscape","author":"Drug Interaction Checker","year":"2021"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jchromb.2013.01.005","article-title":"Development and validation of an assay for the simultaneous determination of zidovudine, abacavir, emtricitabine, lamivudine, tenofovir and ribavirin in human plasma using liquid chromatography-tandem mass spectrometry","volume":"919-920","author":"Kromdijk","year":"2013","journal-title":"Journal of Chromatography B"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1517\/17425255.2015.997207","article-title":"The pharmacokinetics, pharmacodynamics and clinical efficacy of elvitegravir + cobicistat + emtricitabine + tenofovir combination therapy for the treatment of HIV","volume":"11","author":"Raffe","year":"2015","journal-title":"Expert Opinion on Drug Metabolism & Toxicology"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/j.1468-1293.2004.00194.x","article-title":"Pharmacokinetics of emtricitabine, didanosine and efavirenz administered once-daily for the treatment of HIV-infected adults (pharmacokinetic substudy of the ANRS 091 trial)","volume":"5","author":"Molina","year":"2004","journal-title":"HIV Medicine"},{"key":"2023022112504262500_","article-title":"FDA Approved Drug Product: Emtriva (Emtricitabine) Oral Capsules","volume-title":"Gilead Sciences","year":"2018"},{"key":"2023022112504262500_","first-page":"737","volume-title":"Disposition of Toxic Drugs and Chemicals in Man","author":"Baselt","year":"2017","edition":"11th edition"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.cmpb.2010.01.007","article-title":"PKSolver: an add-in program for pharmacokinetic and pharmacodynamic data analysis in Microsoft Excel","volume":"99","author":"Zhang","year":"2010","journal-title":"Computer Methods and Programs in Biomedicine"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.jchromb.2009.05.029","article-title":"The simultaneous assay of tenofovir and emtricitabine in plasma using LC\/MS\/MS and isotopically labeled internal standards","volume":"877","author":"Delahunty","year":"2009","journal-title":"Journal of Chromatography B"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1128\/AAC.02058-13","article-title":"Population pharmacokinetics of emtricitabine in HIV-1-infected adult patients","volume":"58","author":"Valade","year":"2014","journal-title":"Antimicrobial Agents and Chemotherapy"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1081\/CLT-58950","article-title":"Key concepts in postmortem drug redistribution","volume":"43","author":"Yarema","year":"2005","journal-title":"Clinical Toxicology"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1089\/aid.2012.0089","article-title":"Tenofovir, emtricitabine, and tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure","volume":"29","author":"Castillo-Mancilla","year":"2013","journal-title":"AIDS Research and Human Retroviruses"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.cca.2018.10.043","article-title":"The right blood collection tube for therapeutic drug monitoring and toxicology screening procedures: Standard tubes, gel or mechanical separator?","volume":"488","author":"Schrapp","year":"2019","journal-title":"Clinica Chimica Acta"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/00007691-200008000-00011","article-title":"Time-dependent absorption of therapeutic drugs by the gel of the Greiner Vacuette blood collection tube","volume":"22","author":"Dasgupta","year":"2000","journal-title":"Therapeutic Drug Monitoring"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.cca.2011.08.037","article-title":"Influence of separator gel in Sarstedt S-Monovette\u00ae serum tubes on various therapeutic drugs, hormones, and proteins","volume":"413","author":"Schouwers","year":"2012","journal-title":"Clinica Chimica Acta"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1590\/1806-9282.66.s1.82","article-title":"Drug-induced nephrotoxicity","volume":"66","author":"Sales","year":"2020","journal-title":"Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1177\/1060028016660812","article-title":"Tenofovir alafenamide","volume":"50","author":"Gibson","year":"2016","journal-title":"Annals of Pharmacotherapy"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","DOI":"10.1111\/ijcp.14542","article-title":"Evaluation of kidney function tests in HIV-positive patients receiving combined antiretroviral therapy","volume":"75","author":"Aydin","year":"2021","journal-title":"International Journal of Clinical Practice"},{"key":"2023022112504262500_","first-page":"184","article-title":"Is tenofovir alafenamide safer than tenofovir disoproxil fumarate for the kidneys?","volume":"18","author":"Aloy","year":"2016","journal-title":"AIDS Reviews"},{"key":"2023022112504262500_","article-title":"Mitochondrial Toxicity of HIV Nucleoside Reverse Transcriptase Inhibitors","volume-title":"UpToDate","year":"2021"},{"key":"2023022112504262500_","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1161\/CIRCULATIONAHA.119.040631","article-title":"Assessment and treatment of patients with Type 2 myocardial infarction and acute nonischemic myocardial injury","volume":"140","author":"DeFilippis","year":"2019","journal-title":"Circulation"},{"key":"2023022112504262500_","article-title":"Samenvatting van de productkenmerken: Genvoya 150 mg\/150 mg\/200 mg\/10 mg filmomhulde tabletten","volume-title":"Gilead Sciences","year":"2015"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkac056\/45495042\/bkac056.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/47\/1\/e1\/49285437\/bkac056.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/47\/1\/e1\/49285437\/bkac056.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T08:27:49Z","timestamp":1700900869000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/47\/1\/e1\/6654740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,3]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,8,3]]},"published-print":{"date-parts":[[2023,2,21]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkac056","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,1,1]]},"published":{"date-parts":[[2022,8,3]]}}}