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[Iatrogenic adrenal insufficiency secondary to an interaction between ritonavir and inhaled fluticasone. A review of the literature.]
[cushing syndrome]
Highly
effective
antiretroviral
treatment
has
improved
the
life
expectancy
of
human
immunodeficiency
virus
(
HIV
)
infected
patients
,
but
has
led
to
an
increase
in
the
comorbidities
related
to
aging
,
such
as
the
chronic
obstructive
pulmonary
disease
(
COPD
)
.
All
this
implies
the
need
for
a
greater
number
of
drugs
and
an
increasing
risk
of
drugs
interactions
with
antiretroviral
treatment
,
particularly
protease
inhibitors
.
We
report
a
case
of
iatrogenic
adrenal
insufficiency
interaction
secondary
to
ritonavir
and
inhaled
fluticasone
in
an
HIV-infected
patient
with
COPD
.
A
review
was
made
of
the
cases
reported
in
adults
in
the
medical
literature
(
Medline
)
up
to
December
2012
.
A
total
of
34
cases
were
reported
.
The
mean
age
was
48
years
.
The
mean
dose
of
ritonavir
was
187
mg
/
day
,
while
the
fluticasone
dose
was
866
μg
/
day
.
The
average
time
of
the
interaction
between
ritonavir
and
fluticasone
was
8
months
.
In
85
%
of
cases
fluticasone
was
discontinued
at
the
time
of
diagnosis
of
adrenal
insufficiency
/
Cushing
syndrome
.
Almost
all
(
90
%
)
patients
had
a
complete
resolution
of
the
symptoms
after
changing
the
treatment
.
HIV-infected
patients
on
antiretroviral
therapy
with
protease
inhibitor
boosted
with
ritonavir
which
requires
the
use
of
inhaled
corticosteroids
,
beclomethasone
would
be
the
best
treatment
option
.
