indinavir-sulfate and Hemophilia-A

Topics: Acidosis, Lactic; Alkynes; Anti-HIV Agents; Benzoxazines; Cyclopropanes; Didanosine; Hemophilia A; Hemorrhage; HIV Protease Inhibitors; HIV-Associated Lipodystrophy Syndrome; Humans; Indinavir; Nevirapine; Oxazines; Reverse Transcriptase Inhibitors; Stavudine; Zidovudine

Topics: Adolescent; Adult; Anti-HIV Agents; Hemophilia A; Hemorrhage; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Male; Platelet Aggregation; Platelet Aggregation Inhibitors; Reverse Transcriptase Inhibitors; Zidovudine

Many persons with haemophilia suffer from HIV and receive highly active antiretroviral therapy. Three patients received indinavir and required surgery due to ingrown toenails. Two patients suffered from a traumatic subungual haematoma. The treatment protocol is described whereby the pressure exerted onto the germinal layer and the nail bed is relieved in order to alleviate pain and nail matrix damage.

Topics: Adult; Granuloma, Pyogenic; Hematoma; Hemophilia A; Hemophilia B; HIV Protease Inhibitors; Humans; Indinavir; Middle Aged; Nail Diseases; Nails; Nails, Ingrown; Substance-Related Disorders

Topics: Adult; Hemophilia A; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Kidney; Male; Time Factors; Ultrasonography

In July 1996 the Food and Drug Administration (FDA) alerted healthcare providers about 15 case reports of spontaneous bleeding episodes in HIV-positive haemophiliacs taking HIV protease inhibitors. In order to characterize the bleeding associated with HIV protease inhibitor therapy, the FDA's spontaneous adverse event reporting system was searched through 28 February 1997. The bleeding episode reporting rate for persons with haemophilia was compared for HIV protease inhibitors and zidovudine, and the characteristics of haemorrhagic events were compared between individuals with and without haemophilia. There was a substantial predominance of bleeding episodes for haemophiliacs taking HIV protease inhibitors (39 of 67; 58%) as compared with zidovudine (two of 63; 3.2%). A comparison of 39 reports of bleeding in haemophiliacs with 28 in non-haemophiliacs revealed similarities in time to event and type of HIV protease inhibitor implicated, but differences were present concerning location of bleeding and outcome. A greater proportion of haemophiliacs had resolution of their bleeding following discontinuation of their HIV protease inhibitor and recurrence of bleeding following rechallenge, as compared with non-haemophiliacs. HIV-positive haemophiliacs appear to be at an elevated risk of bleeding while taking HIV protease inhibitors, but these medications may predispose all individuals to such complications.

Topics: Adolescent; Adult; Aged; Databases, Factual; Female; Hemophilia A; Hemorrhage; HIV Protease Inhibitors; HIV Seropositivity; Humans; Indinavir; Male; Middle Aged; Nelfinavir; Saquinavir; Treatment Outcome; United States; United States Food and Drug Administration; Zidovudine

Topics: Administration, Oral; Adult; Fenofibrate; Hemophilia A; HIV Infections; HIV Protease Inhibitors; Humans; Hyperlipidemias; Hypolipidemic Agents; Indinavir; Male; Transfusion Reaction

Topics: Hemophilia A; Hemorrhage; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Kidney Calculi; Thrombocytopenia

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; Cohort Studies; Drug Therapy, Combination; Hemophilia A; Hepacivirus; Hepatitis C; HIV; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Reverse Transcriptase Inhibitors; RNA, Viral; Saquinavir; Stavudine; Treatment Outcome; Viral Load; Zidovudine

Nephrolithiasis may be an important consequence of indinavir therapy; however little has been published on the variation in incidence between different populations of patients or the possible mechanisms of calculus formation.. To examine variation in the incidence of indinavir-associated nephrolithiasis (IAN) in HIV-positive patients in relation to hemophilia and hepatitis C virus (HCV) infection.. Clinical data were abstracted retrospectively from the medical records of all adult patients treated with indinavir from September 1995 to September 1997. Occurrence of first IAN, defined as flank pain and hematuria after initiation of therapy, was analyzed in relation to hemophilia status and HCV infection.. There were 17 episodes of IAN (22%) among 79 patients treated with indinavir. Of 10 patients with hemophilia, 50% developed IAN as compared with 17% of patients without hemophilia (P = 0.03). Median days to first IAN was 22 (range 7-110 days) for hemophiliacs and 156 (range 5-611 days) for those without hemophilia. Data for HCV status were available for 74 out of 79 patients: 10 out of 27 (37%) patients with HCV developed IAN compared with six out of 42 (14%) without HCV (P = 0.02).. Overall incidence of IAN was higher than that previously reported and was significantly greater in hemophiliacs than in non-hemophiliacs. HCV may be a contributing factor.

Topics: Adult; Anti-HIV Agents; Female; Hemophilia A; Hepatitis C; HIV Infections; HIV Protease Inhibitors; Humans; Incidence; Indinavir; Kidney Calculi; Male; Risk Factors

A 29-year-old hemophiliac with HIV infection for which he was receiving antiretroviral treatment (ART) with indinavir, zidovudine and zalcitabine reported increasing swelling of the neck. Physical examination noted a soft to doughy swelling, not sensitive to pressure, extending from the neck to between the shoulder blades.. Ultrasonography and magnetic resonance imaging revealed the swelling to consist of an accumulation of subcutaneous fat without capsule. Cytology demonstrated benign fatty tissue. Blood triglycerides totalled 667 mg/dl.. The typical location, absence of a capsule and the cytological finding confirmed the clinical diagnosis of drug-induced benign symmetrical lipomatosis (BSL, also called peripheral lipodystrophy) in ART. A connection with the hyperlipoproteinaemia is supported by the observation that the patient used to have a normal fat metabolism; the onset of BSL coincided with a massive increase in triglyceride levels. The hyperglyceridaemia and clinical signs improved on a low-fat diet.. BSL can occur in the course of ART in HIV infection, when reverse-transcriptase inhibitors or protease inhibitors are being taken. Medication should not be changed, when antiretroviral treatment is adequate. To reduce the symptoms low-fat diet should be tried, as well as administration of HMG-CoA-reductase inhibitors or, if necessary, surgical liposuction.

Topics: Adult; Anti-HIV Agents; Drug Therapy, Combination; Hemophilia A; HIV Infections; Humans; Indinavir; Lipomatosis, Multiple Symmetrical; Male; Zalcitabine; Zidovudine

To report a case of renal toxicity associated with administration of indinavir sulfate in a pediatric hemophiliac with HIV infection.. A 16-year-old white hemophiliac boy with HIV infection secondary to tainted coagulation factor VIII was treated with indinavir sulfate. The patient developed gross hematuria, proteinuria, pyuria, abdominal pain, increased bilirubin, an elevated serum creatinine (SCr) of 1.2 mg/dL (baseline 0.9-1.0), and symptoms of renal colic within 1 month of starting indinavir sulfate therapy. Approximately 2 months later the patient developed a low-grade fever with a further increase in SCr. He was prescribed a 10-day course of cefpodoxime proxetil for a possible urinary tract infection. One week later, the patient developed fever, chills, nausea, vomiting, decreased appetite, sterile pyuria, nasal congestion, and an elevated SCr of 1.3-1.7 mg/dL. Indinavir sulfate and cefpodoxime proxetil were discontinued and the patient was suspected of having tubulointerstitial nephritis secondary to indinavir sulfate. The patient's nephritis resolved and the SCr decreased to 1.1 mg/dL within 1 month of discontinuing indinavir sulfate.. This case demonstrates the potential for renal toxicity with the use of indinavir sulfate in HIV-infected hemophiliacs.

Topics: Adolescent; Factor VIII; Hemophilia A; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Nephritis, Interstitial