ritonavir and Alopecia

Topics: Alopecia; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Atazanavir Sulfate; CD8-Positive T-Lymphocytes; Clone Cells; Dideoxynucleosides; Drug Therapy, Combination; Humans; Immunophenotyping; Lamivudine; Lymphoma, AIDS-Related; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Remission Induction; Ritonavir

Topics: Adenine; Alopecia; Anti-HIV Agents; Antigens, Differentiation, T-Lymphocyte; Antiretroviral Therapy, Highly Active; Atazanavir Sulfate; CD8-Positive T-Lymphocytes; Deoxycytidine; Diagnosis, Differential; Emtricitabine; HIV Infections; Humans; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Oligopeptides; Organophosphonates; Prednisone; Pseudolymphoma; Pyridines; Ritonavir; Skin; Tenofovir

Topics: Adult; Alopecia; Atazanavir Sulfate; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; Humans; Male; Oligopeptides; Pyridines; Ritonavir

A 38-year-old Caucasian woman with uncontrolled human immunodeficiency virus (HIV) infection was treated with highly active antiretroviral therapy (HAART) consisting of zidovudine, lamivudine, and nevirapine. Because her therapeutic response was inadequate, the HAART regimen was changed to abacavir, lamivudine, and lopinavir-ritonavir. Three months after this therapy was started, the patient developed progressive and notable hair loss. Her hair became fair and thin, and her appearance deteriorated considerably. Hair loss due to HAART was diagnosed. Lopinavir-ritonavir was stopped, and efavirenz was substituted; abacavir and lamivudine were continued. After 4 weeks, her hair growth substantially improved, as evidenced by rapid growth of new hair. Her general condition also improved. No relapse was observed with the new HAART regimen, and the patient's hair loss completely reversed in 8 weeks. Alopecia is a possible adverse event in HIV-infected patients treated with protease inhibitors, particularly indinavir. Our patient's severe and generalized alopecia was temporally related to the initiation and discontinuation of lopinavir-ritonavir. On the basis of the Naranjo adverse drug reaction probability scale, the adverse reaction was considered probable. Although generalized hair loss due to lopinavir-ritonavir is rare, clinicians should be aware of this potential adverse reaction of this widely used drug. If alopecia is severe or particularly distressing to the patient, the offending drug should be discontinued, and therapy with another HIV drug should be started.

Topics: Adult; Alkynes; Alopecia; Antiretroviral Therapy, Highly Active; Benzoxazines; Cyclopropanes; Dideoxynucleosides; Drug Combinations; Female; HIV Infections; HIV Protease Inhibitors; Humans; Lamivudine; Lopinavir; Probability; Pyrimidinones; Ritonavir

The most commonly reported side effects related to lopinavir/ritonavir are diarrhea, vomiting, headache, nausea, and increased serum triglycerides and cholesterol levels. About 4% of the patients prescribed lopinavir/ritonavir stop taking it because of side effects. Alopecia, generally involving the scalp, has been reported in patients with HIV infection treated with indinavir but not with lopinavir/ritonavir. We present a 62-year-old man with HIV infection, stage B2, who experienced alopecia totalis of his scalp, eyebrows, and eyelashes beginning 18 months after initiating antiretroviral treatment including lopinavir/ritonavir. No hair loss on the arms, legs, and pubic area was observed. Our patient's drug regimen consisted of lopinavir/ritonavir, efavirenz, and stavudine; in addition, the patient was receiving treatment for diabetes with glivenclamide and metformin for the last 3 years. These drugs have not been shown to cause alopecia. Alopecia reversed completely 2 months after substituting nelfinavir for lopinavir/ritonavir without any other change of treatment and his eyelashes and eyebrows grew back as well. To our knowledge, this is the second case of lopinavir/ritonavir-associated alopecia totalis reported in the international literature.

Topics: Alopecia; Antiretroviral Therapy, Highly Active; HIV Infections; Humans; Lopinavir; Male; Middle Aged; Nelfinavir; Pyrimidinones; Ritonavir; Treatment Outcome

Topics: Adult; Alopecia; Antiretroviral Therapy, Highly Active; Female; HIV Infections; HIV Protease Inhibitors; Humans; Lamivudine; Lopinavir; Nelfinavir; Pyrimidinones; Ritonavir; Stavudine

Topics: Alopecia; Drug Therapy, Combination; HIV Protease Inhibitors; Humans; Indinavir; Ritonavir