ritonavir and Osteonecrosis

Human immunodeficiency virus-infected patients are 100 times more likely to develop aseptic osteonecrosis compared with the general population. While 90% of cases concern the femoral head, the involvement of humeral bone remains rare.. We report a case of aseptic osteonecrosis of the left humeral head complicating antiretroviral therapy in a female, 46-year-old, Bissau-Guinean human immunodeficiency virus-infected patient received in a context of progressive pain in the left shoulder followed by limitation of articular movements. Standard x-ray of the shoulder allowed us to make the diagnosis by showing a typical image of osteonecrosis. The treatment was medical combined with physiotherapy.. Aseptic osteonecrosis should be systematically looked for in human immunodeficiency virus patients on antiretroviral treatment. In addition to femoral head aseptic necrosis, the involvement of the humeral bone should also be considered.

Topics: Emtricitabine; Female; HIV; HIV Infections; Humans; Humeral Head; Lopinavir; Middle Aged; Osteonecrosis; Ritonavir; Tenofovir

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

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: Adenine; Carbamates; Deoxycytidine; Emtricitabine; Furans; HIV Infections; HIV Protease Inhibitors; Humans; Immunocompromised Host; Male; Middle Aged; Organophosphates; Organophosphonates; Orthotic Devices; Osteonecrosis; Reverse Transcriptase Inhibitors; Ritonavir; Sulfonamides; Talus; Tenofovir