fluticasone and HIV-Infections

There are significant drug-drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome.. All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.. A literature search and further cross-referencing yielded a total of seven reports on drug-drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.. The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Adult; Cobicistat; Cushing Syndrome; Drug Interactions; Fluticasone; HIV; HIV Infections; HIV Protease Inhibitors; Humans; Male; Ritonavir

The purpose of this article is to provide a systematic overview of the literature on adrenal suppression and Cushing's syndrome secondary to an interaction between inhaled/intranasal fluticasone and ritonavir. The clinical presentation, diagnosis and management will be discussed.. A literature search using Medline and EMBASE and a search of abstracts of the three previous years of major HIV-related conferences were carried out.. There were 25 cases (15 adult and 10 paediatric) of significant adrenal suppression secondary to an interaction between ritonavir and inhaled fluticasone, and three cases involving ritonavir and intranasal fluticasone. Cases with other steroids were not reported; however, there were cases of adrenal suppression with itraconazole [also a potent cytochrome p (CYP) 3A4 inhibitor] and inhaled budesonide. Clinicians need to differentiate between antiretroviral-induced lipodystrophy syndrome and iatrogenic Cushing's syndrome secondary to glucocorticoid use. Long-term fluticasone and ritonavir should be avoided. If ritonavir is required, another inhaled steroid such as low-dose budesonide or beclomethasone can be used cautiously. Upon discontinuation of inhaled corticosteroids, close monitoring for symptoms of adrenal insufficiency is warranted. The need for steroid replacement therapy at physiological doses should be assessed.. The combination of ritonavir and fluticasone should be avoided. Budesonide, beclomethasone, triamcinolone and flunisolide appear to be safer options.

Topics: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Androstadienes; Child; Child, Preschool; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Infant; Male; Middle Aged; Ritonavir

Topics: Administration, Inhalation; Adult; Androstadienes; Antiviral Agents; Asthma; Biological Availability; Cushing Syndrome; Cytochrome P-450 Enzyme Inhibitors; Drug Therapy, Combination; Fluticasone; Glucocorticoids; HIV Infections; Humans; Lopinavir; Male; Pyrimidinones; Ritonavir

Drug interactions are undesirable events observed in clinical practice. In patients with HIV infection on antiretroviral therapy (ART), it is particularly important to bear in mind that many drugs com monly used in pediatrics can cause such interactions.. to report a case of drug interaction between an antiretroviral drug (lopinavir/ritonavir) and inhaled corticosteroid in a child with HIV infection, and to review more frequent drug interactions in children on ART.. 5-year- old male with history of stage N1 vertical transmitted HIV infection (1994 CDC classification), on ART from 8 months of age with zidovudine, lamivudine, and lopinavir/ritonavir, with successful virological and immunological outcome. Due to symptoms of allergic rhinitis (congestion, itchy nose, and nocturnal snoring) treatment with intranasal fluticasone was started. After 1 month of treatment, he developed cushingoid facies, weight gain, mixed dyslipidemia, insulin resistance, morning basal cortisol levels < 1 µg/dL, and Adrenocorticotropic hormone (ACTH) < 2 pg/ml, presenting ACTH stimulation test compatible with central adrenal insufficiency, attributed to a drug interaction with lopinavir/ritonavir due to known interaction. He started hydrocortisone replacement treatment, recovering hypothalamic-pituitary-adrenal axis function after 18 months.. Knowledge of this and other drug interactions between ART and drugs commonly used in pediatrics is essential for the comprehensive management of patients with HIV infection, especially in the prevention of unwanted adverse effects.

Topics: Administration, Inhalation; Anti-HIV Agents; Anti-Inflammatory Agents; Child, Preschool; Drug Combinations; Drug Interactions; Fluticasone; HIV Infections; Humans; Lopinavir; Male; Rhinitis, Allergic; Ritonavir

Inhaled corticosteroids are generally considered safe and do not usually lead to systemic adverse events since their plasma concentrations are low due to hepatic metabolism by the cytochrome P450 3A4. However, when associated with inhibitors of this cytochrome, such as ritonavir, they may lead to iatrogenic Cushing syndrome by the systemic accumulation of corticosteroids and consequent suppression of the hypothalamic-pituitary-adrenal axis. We present a case of iatrogenic Cushing syndrome complicated by multifocal osteonecrosis in a patient with HIV infection on antiretroviral therapy with protease inhibitors boosted with ritonavir, after the association of inhaled fluticasone. This clinical case highlights a relevant interaction between corticosteroids and inhibitors of the cytochrome P450 and the severe consequences that may occur.

Topics: Administration, Inhalation; Adult; Bronchodilator Agents; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Iatrogenic Disease; Male; Osteonecrosis; Pulmonary Disease, Chronic Obstructive; Ritonavir

The increase in life expectancy with the advent of highly effective antiretroviral therapy poses challenges in terms of toxicity and drug interactions. Exogenous Cushing syndrome by interaction between ritonavir and inhaled fluticasone in children diagnosed with human immunodeficiency virus infection and chronic pulmonary pathology is rare. So far, there are 20 cases reported. Three pediatric cases are reported, with a diagnosis of human immunodeficiency virus infection and chronic pulmonary pathology who presented exogenous Cushing syndrome with inhaled fluticasone at usual doses due to drug interaction between it and ritonavir. The patients resolved the clinical picture after 2-4 months of fluticasone suspension and remain asymptomatic in the follow-up.. El incremento de la expectativa de vida con el advenimiento de la terapia antirretroviral de alta eficacia plantea desafíos en cuanto a la toxicidad e interacciones medicamentosas. El síndrome de Cushing exógeno por interacción entre ritonavir y fluticasona inhalada en niños con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica es infrecuente. Hasta el momento, hay 20 casos reportados. Se describen 3 casos pediátricos con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica que presentaron síndrome de Cushing exógeno con fluticasona inhalada en dosis habituales por la interacción medicamentosa entre esta y ritonavir. Los pacientes resolvieron el cuadro clínico luego de 2-4 meses de suspensión de la fluticasona y permanecieron asintomáticos en el seguimiento.

Topics: Administration, Inhalation; Adolescent; Anti-HIV Agents; Asthma; Bronchodilator Agents; Child; Chronic Disease; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; Humans; Lung Diseases, Interstitial; Male; Ritonavir

Topics: Administration, Inhalation; Bronchodilator Agents; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Male; Middle Aged; Muscular Diseases; Pulmonary Disease, Chronic Obstructive; Ritonavir

Topics: Adrenal Insufficiency; Adult; Aged; Comorbidity; Cushing Syndrome; Drug Interactions; Female; Fluticasone; HIV Infections; Humans; Iatrogenic Disease; Male; Middle Aged; Ritonavir; Steroids; Triamcinolone; Young Adult

Ritonavir is a powerful inhibitor of the cytochrome P450 3A4 (CYP3A4) isoenzyme. It is used as a pharmaceutical enhancer in the management of HIV-positive patients. However, when co-administered with other drugs that are metabolised via the CYP3A4 pathway, ritonavir can potentially cause serious drug-drug interactions. Inhaled fluticasone propionate, which is used to treat asthma and chronic obstructive airway disease, is particularly prone to such interactions due to its physiological attributes. We report a HIV-positive 48-year-old male patient who presented to Al Nahdha Hospital, Muscat, Oman, in 2012 with weight loss, generalised weakness and fatigue and diagnosed with secondary adrenal insufficiency as a result of concomitant ritonavir and inhaled fluticasone.

Topics: Administration, Inhalation; Adrenal Insufficiency; Asthma; Bronchodilator Agents; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Male; Middle Aged; Oman; Ritonavir

We report a 41-year-old man with HIV and a chronic obstructive pulmonary disease, treated for seven months with Fluticasone/Salmeterol and antiretroviral therapy (Lamivudine, Tenofovir, Atazanavir and Ritonavir). While using these medications, the patients developed a Cushing syndrome in a period of five months. After performing laboratory and imaging tests, it was concluded that the most probable cause of the syndrome was the interaction of inhaled steroids with Ritonavir. After discontinuing these medications the syndrome reverted in a period of 8 months.

Topics: Adult; Bronchodilator Agents; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Male; Nebulizers and Vaporizers; Salmeterol Xinafoate

The advent of highly active antiretroviral therapy for HIV infection dramatically changed the landscape of the disease. Ritonavir, a protease inhibitor (PI) frequently used in low doses to 'boost' the concentrations of other PIs, inhibits the cytochrome P450 3A4 isoenzyme, a common metabolic pathway to multiple drugs, so the potential for drug interactions is not negligible. A 39-year-old man with HIV-1 infection, treated with a ritonavir-boosted PI, was started on fluticasone/salmeterol inhaler and intranasal fluticasone, in 2009, in the setting of asthma and allergic rhinitis. In 2013, he presented with 1-year evolution of symptoms suggesting Cushing's syndrome, and was experiencing recurrent falls. A spine CT showed a vertical L3 fracture and thoracolumbar erosions; a bone density scan revealed severe osteoporosis. Hormonal assays were compatible with hypothalamic-pituitary-adrenal axis suppression, and iatrogenic Cushing's syndrome due to ritonavir-fluticasone interaction was considered. Fluticasone was suspended and oral corticosteroid replacement initiated, with a favourable outcome.

Topics: Accidental Falls; Adult; Anti-Allergic Agents; Asthma; Bronchodilator Agents; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Iatrogenic Disease; Male; Osteoporosis; Rhinitis, Allergic; Ritonavir

We report a case of severe bilateral knee avascular necrosis in a HIV-positive man receiving ritonavir and inhaled fluticasone. This case highlights the need for a thorough medication history in patients on ritonavir-based antiretroviral therapy, especially where multiple prescribers are involved in the patient's care.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Androstadienes; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Magnetic Resonance Imaging; Male; Osteonecrosis; Ritonavir; Treatment Outcome

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Cushing Syndrome; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Ritonavir

A 52-year-old man with well-controlled HIV infection taking ritonavir and increasing doses of inhaled fluticasone for chronic bronchitis developed thrush. Within days of discontinuing fluticasone and initiating fluconazole, he presented with fatigue, malaise, lower-extremity oedema and orthostasis. Testing confirmed exogenous Cushing's syndrome and secondary adrenal insufficiency. Although ritonavir-fluticasone interactions have been previously reported as a cause for adrenal insufficiency, we propose that fluconazole increased the rapidity of onset and severity of symptoms through synergistic inhibition of the adrenal axis.

Topics: Adrenal Insufficiency; Androstadienes; Anti-HIV Agents; Anti-Inflammatory Agents; Bronchitis; Drug Interactions; Fluconazole; Fluticasone; HIV Infections; Humans; Male; Middle Aged; Ritonavir

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Anti-Retroviral Agents; Delivery of Health Care, Integrated; Disease Management; Drug Interactions; Fluticasone; HIV Infections; Humans; Hyperlipidemias; Hypolipidemic Agents; Interdisciplinary Communication; Male

Inhalation of fluticasone is usually devoid of systemic side-effects. The authors describe a case of a young HIV positive woman treated concomitantly with fluticasone and inhibitors of HIV protease ritonavir and lopinavir in which developed a serious endocrine side-effect - an iatrogenic Cushing's syndrome. Plasma concentration of cortisol < 5.5 nmol/l was very low (norm 250-650 nmol/l) and plasmatic ACTH was even not detectable. The administration of fluticasone and both inhibitors of HIV protease was stopped and substitution therapy with decreasing dose of hydrocortisone was initiated. Twenty weeks later resolved both clinical and laboratory symptoms of Cushing's syndrome, and the substitution therapy with hydrocortisone was terminated. Two years later became the patient pregnant and gave birth to a healthy child.

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Allergic Agents; Asthma; Cushing Syndrome; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Ritonavir; Young Adult

Ritonavir, a protease inhibitor (PI), is commonly used in the treatment of HIV-1 infection. It is a potent inhibitor of the hepatic cytochrome P450 superfamily. Therefore, its usage with other PI medications leads to significant increases in the levels of the latter PI, which allows a reduction in pill burden. Intranasal and inhaled corticosteroids are widely used for the treatment of allergic rhinitis and asthma. Inhaled steroids do not usually lead to systemic adverse events, since their plasma concentrations are quite low due to extensive first-pass metabolism and clearance by CYP3A4. However, 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 Cushing's syndrome (laboratory and clinical) with adrenal suppression.. Plasma cortisol and urinary-free cortisol levels were determined using immunoassays. In the Synacthen test, plasma cortisol levels were measured at time 0 as well as at times 60, 120, and 150 minutes following an intramuscular injection of 0.25 mg Synacthen.. We present here three HIV-1 female patients aged 12, 55 and 65 years who developed iatrogenic Cushing's syndrome with adrenal suppression following the coadministration of Ritonavir and inhaled Fluticasone, both at the standard recommended doses.. The coadministration of Ritonavir and Fluticasone at the recommended doses caused, in our three patients, iatrogenic Cushing's syndrome with adrenal suppression. We suggest that this adverse event is underdiagnosed and high clinical suspicion is needed for early diagnosis and prenention of Addisonian crises. Thus, Fluticasone treatment should be avoided in patients who are treated with Ritonavir. Alternative therapeutic options for asthma control such as oral Montelukast or bronchodilators alone should be considered.

Topics: Administration, Inhalation; Aged; Androstadienes; Antiretroviral Therapy, Highly Active; Asthma; Bronchodilator Agents; Child; Cushing Syndrome; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Hydrocortisone; Middle Aged; Ritonavir

Patients with HIV/AIDS are often afflicted with oesophageal disorders. Opportunistic infections such as candidiasis, herpes simplex, cytomegalovirus, mycobacterial infections, Kaposi sarcoma or lymphoma involving the oesophagus, motility disorders and reflux oesophagitis are the usual culprits. Eosinophilic oesophagitis (EE), a recently recognized entity, is an important cause of dysphagia, food impaction and chest discomfort. We report the case of an HIV-infected man who had persistent dysphagia for six months despite treatment with proton pump inhibitor. He was diagnosed with EE after having endoscopic evaluation and biopsy of his oesophagus and was successfully treated with swallowed fluticasone. This case represents the first reported case of EE in an HIV-infected individual.

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Biopsy; Deglutition Disorders; Endoscopy; Eosinophilic Esophagitis; Fluticasone; Histocytochemistry; HIV Infections; Humans; Male; Proton Pump Inhibitors

Ritonavir and atazanavir (ATZ) are protease inhibitors (PI) that inhibit the P450 3A4 cytochrome. They are used together to boost ATZ levels and reduce pill burden in human immunodeficiency virus infection, but association with medications metabolized by this cytochrome can cause serious adverse effects. Several cases of Cushing's syndrome have been reported when patients received inhaled therapy with fluticasone for asthma, sometimes complicated by secondary adrenal failure after stopping fluticasone. We report a case of Cushing's syndrome associated with onset of diabetes mellitus in a patient treated with boosted PI (ATZ and ritonavir) for HIV 2 (CD4360/ml). Asthma was treated with inhaled fluticasone 1500mug/day for several months that was stopped at admission. A few days later, typical secondary adrenal failure developed and was confirmed by dosage of cortisol and ACTH, both low. Hydrocortisone replacement treatment resulted in rapid improvement of symptoms. Diabetes was initially treated with insulin then sulfonyluraes, but repeated hypoglycemias lead to diet alone. Physicians should be aware of the potential danger of the association of "boosted" IP and some kind of inhaled corticotherapy.

Topics: Administration, Inhalation; Adrenocorticotropic Hormone; Androstadienes; Blood Glucose; Bronchodilator Agents; Creatinine; Cushing Syndrome; Diabetes Complications; Diet, Diabetic; Fluticasone; Glycated Hemoglobin; HIV Infections; HIV Protease Inhibitors; HIV-2; Humans; Hydrocortisone; Male; Middle Aged; Ritonavir; Thyroxine

This case report describes an exacerbation of AIDS-associated Kaposi sarcoma (KS) in the setting of iatrogenic Cushing syndrome caused by an interaction between ritonavir-boosted atazanavir and fluticasone. Discontinuation of fluticasone resulted in resolution of the cutaneous KS. Clinicians should be aware of this potential drug-drug interaction that can result in increased corticosteroid levels. Inhaled corticosteroids should be used cautiously in persons with HIV/AIDS who have a history of KS and are being treated with a boosted atazanavir regimen because this can potentially exacerbate KS.

Topics: Androstadienes; Anti-Inflammatory Agents; Atazanavir Sulfate; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Iatrogenic Disease; Male; Middle Aged; Oligopeptides; Pyridines; Ritonavir; Sarcoma, Kaposi

A 14-year-old female with perinatally acquired HIV on boosted protease inhibitor (PI) therapy with atazanavir and ritonavir rapidly developed cushingoid features with excessive weight gain and moon facies within 2 weeks of receiving inhaled fluticasone/salmeterol for asthma treatment. Soon after discontinuing PIs and inhaled steroid, she required hospitalization for dyspnea, headache, muscle weakness, and extreme fatigue requiring hydrocortisone replacement therapy for presumed adrenal insufficiency. Cushing syndrome and adrenal suppression were very likely caused by elevated steroid systemic concentrations resulting from the cytochrome p450 interaction between the protease inhibitors and fluticasone. The Naranjo probability scale score of 5 suggests that the event was probably drug related. This is the first case report of fluticasone and PI-induced Cushing syndrome and adrenal suppression in a pediatric patient without a history of recent or concomitant treatment with systemic steroid therapy. Additionally, this case is unique as it is the most rapid (<2 weeks) presentation documented, thus far. Health care professionals should be conscious of this important drug-drug interaction in HIV-infected children and adolescents and be aware that rapid onset of hypercortisolism and adrenal suppression are possible.

Topics: Adolescent; Adrenal Insufficiency; Albuterol; Androstadienes; Anti-HIV Agents; Anti-Inflammatory Agents; Atazanavir Sulfate; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Female; Fluticasone; HIV Infections; Humans; Hydrocortisone; Oligopeptides; Pyridines; Ritonavir; Salmeterol Xinafoate

Topics: Administration, Inhalation; Adrenal Insufficiency; Androstadienes; Asthma; Bronchodilator Agents; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Ritonavir

We present 2 cases of Cushing syndrome with secondary adrenal insufficiency from concomitant use of ritonavir and inhaled corticosteroids in children with human immunodeficiency virus infection. These cases highlight the need for special consideration when treatment with an inhaled/intranasal corticosteroid is indicated in children receiving antiretroviral therapy.

Topics: Administration, Inhalation; Adolescent; Adrenal Insufficiency; Albuterol; Androstadienes; Asthma; Bronchodilator Agents; Child; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Ritonavir; Salmeterol Xinafoate

Ritonavir, a potent inhibitor of CYP3A4 enzyme, can lead to high systemic concentrations of fluticasone when these 2 drugs are coadministered. Exogenous Cushing syndrome (CS) in HIV-infected patients receiving ritonavir and fluticasone has been reported frequently in adults but not in children. Three patients, all receiving ritonavir-fluticasone, developed weight gain and altered fat distribution concerning for either lipodystrophy or CS.. Three patients were initially identified by their clinicians as having weight gain and altered fat distribution concerning for either lipodystrophy or CS. All 3 patients were receiving fluticasone and ritonavir, leading to concern about a potential medication interaction. After suspecting exogenous CS, all patient medication lists were reviewed to identify all children prescribed ritonavir-fluticasone. Blood adrenocorticotropic hormone (ACTH) and cortisol were obtained during routine clinic visits. Medication history, laboratory data and physical examination findings were abstracted from medical records.. Seventeen (9%) of 189 patients in this pediatric HIV clinic had been prescribed ritonavir-fluticasone. Of 7 patients still taking ritonavir-fluticasone, CS features were present in 4 (57%) patients, including the 3 patients initially suspected of CS or lipodystrophy. Five (71%) patients, including all 4 with CS features, had low serum concentrations: median cortisol <0.2 microg/dL (normal, <0.2 microg/dL). Three of these 5 had ACTH measured, all of which were low: median ACTH 3.0 pmol/L (range, 2.2-<5.0 pmol/L). One patient taking ritonavir-fluticasone had suppressed cortisol but no CS features. The 2 patients with normal serum cortisol and ACTH values had persistent HIV viremia and were suspected of medication nonadherence. Clinical and laboratory abnormalities generally normalized in affected patients within 3 months after discontinuation of fluticasone alone (2) and ritonavir-fluticasone (3).. Pediatric HIV physicians frequently prescribe fluticasone and ritonavir together. The combination can cause CS and adrenal suppression in children, potentially leading to misdiagnosis of lipodystrophy syndrome and to increased risk of adrenal crisis during acute illness. Alternatives to fluticasone should be used for treating children receiving ritonavir.

Topics: Adolescent; Adult; Androstadienes; Anti-Inflammatory Agents; Child; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Female; Fluticasone; HIV Infections; HIV Protease Inhibitors; HIV-Associated Lipodystrophy Syndrome; Humans; Infant; Male; Ritonavir

Topics: Aged; Androstadienes; Anti-Inflammatory Agents; Asthma; Cushing Syndrome; Drug Interactions; Drug Therapy, Combination; Fluticasone; HIV Infections; HIV Protease Inhibitors; Humans; Hydrocortisone; Male; Ritonavir

Topics: Adult; Androstadienes; Anti-HIV Agents; Cushing Syndrome; Female; Fluticasone; HIV Infections; HIV-1; Humans; Puerperal Disorders; Ritonavir

International guidelines recommend prescription of inhaled corticosteroids to improve asthma control. Chronic secondary adrenal suppression due to inhaled corticosteroids has been described. We report a case of acute adrenal suppression due to drug interaction between Fluticasone and antiretroviral therapy in a HIV patient. Seeing an increased prevalence of hyperresponsiveness among HIV-infected men, we conclude that coprescription of Fluticasone and highly active antiretroviral therapy must be carefully controlled.

Topics: Acute Disease; Administration, Inhalation; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Androstadienes; Anti-Inflammatory Agents; Antiretroviral Therapy, Highly Active; Asthma; Fluticasone; HIV Infections; Humans; Hydrocortisone; Male

In HIV-infected patients, ritonavir, a potent cytochrome P450 inhibitor, is increasingly used to improve the pharmacokinetic profile of the associated protease inhibitor. HIV physicians are often faced with potential drug-drug interaction while treating associated diseases. We report the case of an HIV-infected patient with clinical features of Cushing's syndrome due to the interaction of low dose ritonavir with inhaled fluticasone propionate (FP). Safety of life-long CYP450 inhibition has still to be demonstrated.

Topics: Adult; Androstadienes; Anti-HIV Agents; Anti-Inflammatory Agents; Asthma; Cushing Syndrome; Drug Interactions; Fluticasone; HIV Infections; Humans; Male; Ritonavir

Topics: Administration, Inhalation; Adult; Androstadienes; Cushing Syndrome; Cytochrome P-450 Enzyme Inhibitors; Depression, Chemical; Drug Therapy, Combination; Fluticasone; Glucocorticoids; HIV Infections; Humans; Male; Ritonavir

We conducted a single case (N-of-1) randomized trial in two patients. In the first case with bronchiolitis obliterans after lung transplantation a beneficial effect of inhaled steroids could be documented. The second patient suffered from symptoms compatible with HIV-associated M. Addison improving after cortisone, but the adrenocortical function was normal. Because the patient required the cortison treatment to be continued, we performed a n-of-1 trial which demonstrated the inefficacy of cortisone. This experience underscores the feasibility and usefulness of N-of-1 randomized clinical trials in medical practice.

Topics: Addison Disease; Administration, Inhalation; Adult; Androstadienes; Anti-Asthmatic Agents; Bronchiolitis Obliterans; Cortisone; Double-Blind Method; Female; Fluticasone; Graft Rejection; HIV Infections; Humans; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome