ritonavir and Pulmonary-Embolism

The return of COVID-19 symptoms after Nirmatrelvir/Ritonavir (Nm/R) treatment is being increasingly reported. Limited evidence suggests most cases of rebound symptoms are mild and do not require further intervention. Here we present a male veteran reporting rebound symptoms who was found to be hypoxic with pulmonary emboli. Our case highlights the need to evaluate known complications of SARS-CoV-2 including venous thromboembolism in patients reporting recurring symptoms. Further, cases of severe rebound phenomenon should continue to be reported by clinicians to better appreciate the use of the Nm/R during the Omicron wave and among vaccinated persons.

Topics: Acute Disease; COVID-19; COVID-19 Drug Treatment; Humans; Male; Pulmonary Embolism; Ritonavir; SARS-CoV-2

Hypercoagulability and thrombosis caused by coronavirus disease 2019 (COVID-19) are related to the higher mortality rate. Because of limited data on the antiplatelet effect, we aimed to evaluate the impact of aspirin add-on therapy on the outcome of the patients hospitalized due to severe COVID-19. In this cohort study, patients with a confirmed diagnosis of severe COVID-19 admitted to Imam Hossein Medical Center, Tehran, Iran from March 2019 to July 2020 were included. Demographics and related clinical data during their hospitalization were recorded. The mortality rate of the patients was considered as the primary outcome and its association with aspirin use was assessed. Nine hundred and ninety-one patients were included, of that 336 patients (34%) received aspirin during their hospitalization and 655 ones (66%) did not. Comorbidities were more prevalent in the patients who were receiving aspirin. Results from the multivariate COX proportional model demonstrated a significant independent association between aspirin use and reduction in the risk of in-hospital mortality (0.746 [0.560-0.994], p = 0.046). Aspirin use in hospitalized patients with COVID-19 is associated with a significant decrease in mortality rate. Further prospective randomized controlled trials are needed to assess the efficacy and adverse effects of aspirin administration in this population.

Topics: Adenosine Monophosphate; Adult; Aged; Alanine; Antiviral Agents; Aspirin; Blood Platelets; Coronary Artery Disease; COVID-19; COVID-19 Drug Treatment; Diabetes Mellitus; Disseminated Intravascular Coagulation; Drug Combinations; Female; Hospital Mortality; Humans; Hypertension; Iran; Lopinavir; Lung; Male; Middle Aged; Platelet Aggregation Inhibitors; Pulmonary Embolism; Respiration, Artificial; Retrospective Studies; Ritonavir; SARS-CoV-2; Severity of Illness Index; Survival Analysis; Treatment Outcome

We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South Africa. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery.

Topics: Adult; Alkynes; Anti-Bacterial Agents; Benzoxazines; Cannabis; Cyclopropanes; Endocarditis; Heroin; HIV Infections; Humans; Illicit Drugs; Male; Methamphetamine; Pulmonary Embolism; Ritonavir; South Africa; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Young Adult

Topics: Anti-HIV Agents; Anti-Inflammatory Agents; Cushing Syndrome; Humans; Iatrogenic Disease; Male; Middle Aged; Pulmonary Embolism; Ritonavir; Triamcinolone

Vein thrombosis risk and pulmonary embolism seem to be more important among human immunodeficiency virus (HIV) infected patients.. We performed a retrospective study including 780 HIV positive patients followed-up between January 2000 and June 2005 at the University Hospital of Clermont-Ferrand.. Among the 780 HIV-infected patients, six cases of thromboembolic events were identified including, four with pulmonary embolism. All the patients were receiving lopinavir/ritonavir combination.. Although uncommon, pulmonary embolism occurs more frequently among HIV positive patients than in general population. Clinicians must remain aware about the possibility of the occurrence of a thromboembolic event especially during the first few months after introduction of the antiretroviral therapy.

Topics: Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Cohort Studies; Female; Follow-Up Studies; France; HIV Protease Inhibitors; HIV Seropositivity; Humans; Lopinavir; Male; Middle Aged; Pulmonary Embolism; Pyrimidinones; Retrospective Studies; Ritonavir; Venous Thrombosis