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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
.
Diseases
Validation
Diseases presenting
"immunodeficiency"
symptom
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
cushing syndrome
dracunculiasis
hirschsprung disease
hodgkin lymphoma, classical
homocystinuria without methylmalonic aciduria
kabuki syndrome
legionellosis
malignant atrophic papulosis
oculocutaneous albinism
omenn syndrome
papillon-lefèvre syndrome
primary effusion lymphoma
primary hyperoxaluria type 1
pyomyositis
severe combined immunodeficiency
sneddon syndrome
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated