Snapshot
- A 34-year-old man presents to the emergency room with acute epigastric pain. He denies any alcohol use. He is HIV-positive currently on highly active antiretroviral therapy. His past medical history is significant for a cholecystectomy 5 years ago without any complications. Laboratory evaluation reveals normal electrolytes, including calcium. A CT scan of his abdomen reveals acute pancreatitis. Upon careful review of his medications, 1 antiretroviral medication in particular increased this patient’s risk for acute pancreatitis. (Acute pancreatitis induced by a protease inhibitor)
Introduction
- Drugs
- atazanavir
- darunavir
- fosamprenavir
- indinavir
- lopinavir
- nelfinavir
- ritonavir
- saquinavir
- tipranavir
- Mechanism of action
- inhibits HIV-1 protease (pol gene), which cleaves HIV mRNA
- prevents complete development of new viruses
- Mechanism of resistance
- usually requires multiple mutations in the pol gene
- Clinical use
- highly active antiretroviral therapy (HAART)
- second-line therapy for patients resistant to first-line therapies
- Adverse effects
- hyperglycemia
- gastrointestinal upset
- saquinavir
- acute pancreatitis
- indinavir-specific side effects
- nephropathy
- kidney stones
- hematuria
- thrombocytopenia
- interaction with rifampin (CYP450 inducer)
- rifampin decreases concentrations of protease inhibitors in the body
- rifabutin is recommended in patients on HAART
- ritonavir
- CYP450 inhibitor