Tuesday, 9 December 2014
Exhibition Hall-Poster Area (Sul America)
Monica Soares De Souza, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Monica De Britto Pereira Bandeira De Mello, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Jaqueline Ribeiro Toscano De Brito, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Karla Do Carmo Ferrão, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Mara Morelo Rocha Felix, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Jaqueline Coser Vianna, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Aniela Bonorino Xexeo Castelo Branco, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Raquel Grinapel, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Cintia Bordalo, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Sônia Hoana Silva, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Marinauria Leal Pinto, MD
,
Pediatric Allergy and Immunology, Federal Hospital of Servidores Do Estado, Rio de Janeiro, Brazil
Background: Drug-drug interactions may explain an important part of the systemic adverse effects in many patients. Recent studies showed the incidence of adrenal insufficiency in users of inhaled corticosteroids, involving fluticasone, budesonide or beclomethasone. FLU, a potent glucocorticoid, is rapidly metabolized by CYP3A4 with minimal systemic effects at recommended doses. However, the association with RTV, a potent enzymatic inhibitor, used in low doses to boost levels of other protease inhibitor in HIV patients, induces CS.
Methods: Report of CS due to RTV /FLU interaction and literature review.
Results: ACS, Birth: 07/07/06, female, AIDS diagnostic at 7 years old, had begun antiretroviral therapy (ZDV/3TC/NVP) in 2010. In 2011/12 developed asthma attacks and lung deterioration due to the late diagnostic and poor treatment adherence. FLU/salmeterol inhalation was intruduced on Jan/13. She had partial improvement of the respiratory symptoms, developing bronchiectasis. Genotyping was performed on Jun/13, confirming treatment failure. Therapy was changed from NVP to LOP / RTV and TDF. ZDV/3TC and inhalation therapy were maintained. Two months later, she gained 8kg, acquired Cushingoid face, hirsutism, acanthosis nigricans, centripetal obesity and mild hypertension. FLU / salmeterol were replaced to beclomethasone (BCL) / salbutamol because of adrenal insufficiency hypothesis caused by RTV/ FLU association. Diagnosis was confirmed by low cortisol levels (0.08 mcg / dL). Physiologic dosage of prednisone was prescribed to avoid Addison crisis. Measurements of free T4, TSH, insulin and biochemical were within normal range. Normal head and abdomen CT. A week later, she lost weight and reduced the adverse symptoms.
Conclusions: RTV and FLU are metabolized by the same cytochrome P450-3A4 (CYP3A4). The co-administration causes increased serum corticosteroids, inducing complications such as CS. The oral prednisone will be continued until the cortisol levels returns to normal range. Clinicians should be aware of the possible adverse effects of the associations of multiple drugs during the treatment of AIDS patients.
