paronychia (inflammation of skin near the nails). The drug 3TC (Epivir) has been linked to paronychia, but only one of the 5 cases reported was also taking 3TC. Ingrown toenails can be treated with minor surgery, best performed by a podiatrist. The researchers stress that as indinavir/ritonavir combinations become more widely used, dose-related adverse events like ingrown toenails, kidney stones, and elevated liver enzyme levels in the blood may increase in frequency. They recommend that health care providers examine the hands and feet of patients taking 3TC and indinavir, especially in combination with ritonavir. Also, the decision of whether or not to continue the same therapy should be made with the patient.
neuromuscular degeneration. Unlike patients with classic ALS, the HIV-infected individuals experienced stabilization or partial recovery of their disease after starting anti-HIV therapy. Many of these patients were identified with symptoms before anti-HIV combination therapy was available. The incidence of ALS is relatively rare, but people with HIV are 27 times more likely to suffer ALS symptoms than the general population. An editorial in the same issue of Neurology (p. 945) points out that ALS syndromes can have many causes ranging from heavy metal toxicity to thyroid disease. The authors recommend that when a patient has classic symptoms of ALS, a viral cause should be considered since HIV-associated ALS is treatable with anti-HIV therapy.
neuromuscular weakness" in HIV-infected individuals (5 of whom died) prompted Bristol-Myers Squibb, the company that makes ddI (Videx) and d4T (Zerit), to issue a special notice to doctors. The neuromuscular weakness resembles a disease called Guillain-Barré syndrome. The 14 patients were taking nucleoside reverse transcriptase inhibitors (NRTIs), a family of anti-HIV drugs that includes ddI, d4T, ddC (Hivid), 3TC (Epivir), AZT (Retrovir), and abacavir (Ziagen). 3TC and AZT are available in one pill called Combivir. Abacavir, AZT, and 3TC are available in one pill called Trizivir. The letter states that in most of the 14 cases, early symptoms of lactic acidosis preceded the neuromuscular problems. These symptoms include nausea, diarrhea, abdominal pain, rapid breathing, muscle pain or cramps, and feelings of tingling or pricking of the skin. According to the letter, muscle weakness should now be added to this list of symptoms. Severe lactic acidosis can lead to kidney or liver failure, pancreatitis, or paralysis, and is usually fatal. If drug-induced lactic acidosis is caught early, stopping the drug(s) can reverse it.
Cushing's syndrome were reported at the 13th Annual Conference of the Australasian Society of HIV Medicine in Melbourne, Australia. The patients were HIV-infected and taking ritonavir (Norvir) as well as fluticasone (Flovent). Ritonavir is a protease inhibitor used for treating HIV and fluticasone is an inhaled corticosteroid used for treating asthma. Symptoms of Cushing's syndrome developed in one patient after taking both drugs for 5 months. The other patient developed symptoms after taking both drugs for 20 months. Symptoms resolved after one of the two drugs was stopped. Healthcare professionals who treat HIV should be aware of this potential drug interaction. Since Cushing's syndrome is caused by an overproduction of corticosteroids in the body, ritonavir may be slowing down the liver's metabolism of fluticasone, causing it to build up. Ritonavir acts in a similar (and beneficial) way with other protease inhibitors like indinavir (Crixivan) and saquinavir (Fortovase), causing the levels of these drugs to increase in the blood. This is the idea behind the anti-HIV drug Kaletra, which is made up of ritonavir and another protease inhibitor called lopinavir.
This article was provided by The Center for AIDS. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.