Abstract
Ritonavir is commonly used in low doses to boost plasma levels of protease inhibitors in patients with human immunodeficiency virus (HIV) infections. It is also a potent inhibitor of cytochrome P450. We present a 50-year-old African American male with past medical history of HIV on highly active antiretroviral therapy (HAART), which also included ritonavir and long standing asthma that has been treated with inhaled fluticasone, who presented with back pain. He had central obesity, prominent abdominal striae and wasted extremities on physical examination. Laboratory tests showed low morning serum cortisol and suboptimal cosyntropin test consistent with adrenal insufficiency. Computed tomography (CT) of the spine showed a fracture of inferior endplate of the lumbar (L3) vertebra. The cause of osteoporosis is believed to be iatrogenic Cushing syndrome caused by enhanced levels of inhaled fluticasone effects secondary to inhibition of cytochrome P450. The patient was managed surgically and fluticasone was discontinued.
Highlights
A potent inhibitor of the hepatic cytochrome P450 is commonly used in low doses to boost plasma levels of other protease inhibitors in patients with human immunodeficiency virus (HIV) [1]
A 50-year-old African American male patient with a past medical history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) for 15 years and long standing asthma that has been treated with inhaled fluticasone 200mcg/day and as needed
For his HIV, he had been initially treated with abacavir and efavirenz which was later changed to Truvada one tablet, atazanavir 300mg, and ritonavir 100mg oral daily because of virologic failure
Summary
A potent inhibitor of the hepatic cytochrome P450 is commonly used in low doses to boost plasma levels of other protease inhibitors in patients with human immunodeficiency virus (HIV) [1]. The coadministration of ritonavir with inhaled (or intranasal) corticosteroids may result in an increase in the plasma corticosteroid levels due to the potent CYP3A4 inhibition by ritonavir This may cause iatrogenic Cushing's syndrome with adrenal suppression [2]. For his HIV, he had been initially treated with abacavir and efavirenz which was later changed to Truvada one tablet, atazanavir 300mg, and ritonavir 100mg oral daily because of virologic failure.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
