ABSTRACT
We describe the case of a HIV-positive patient treated for visceral leishmaniasis who developed uveitis as part of a leishmaniasis immune reconstitution syndrome. Visceral leishmaniasis is increasingly found in HIV-positive adults. Its ophthalmic manifestations can range from relatively minor to complicated anterior uveitis, leading to secondary glaucoma and loss of vision. Clinicians caring for people living with HIV should be alert to the complications of leishmaniasis that can occur before and during treatment.
Subject(s)
AIDS-Related Opportunistic Infections/complications , HIV Infections/complications , Homosexuality, Male , Immune Reconstitution Inflammatory Syndrome/complications , Leishmaniasis, Visceral/complications , Uveitis/etiology , Adult , Anti-HIV Agents/therapeutic use , Fever/etiology , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Leishmania donovani/isolation & purification , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Male , Splenomegaly/etiology , Treatment Outcome , Uveitis/diagnosis , Uveitis/drug therapyABSTRACT
This case report describes two severe antiretroviral drug adverse reactions that occurred in the same patient. A 55-year-old HIV-positive African woman received a single epidural triamcinolone injection for pain relief of postherpetic neuralgia. Forty-one days later, she developed severe iatrogenic Cushing's syndrome due to the drug-drug interaction between triamcinolone and her boosted protease inhibitor therapy. The patient's antiretroviral regimen was thus changed to replace her protease inhibitor with the integrase inhibitor raltegravir. Shortly after commencing the drug, the patient developed a severe adverse drug reaction manifesting as Drug Reaction (or Rash) with Eosinophilia and Systemic Symptoms (DRESS) syndrome. First described in 1996, this hypersensitivity syndrome presents with severe skin reaction as well as fever, rash, lymphadenopathy and internal organ involvement with marked eosinophilia. Clinicians should be aware of raltegravir-induced DRESS syndrome as well as the potential for drug-drug interactions due to protease inhibitor-based therapy.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Drug Hypersensitivity Syndrome , HIV Integrase Inhibitors/adverse effects , Neuralgia, Postherpetic/drug therapy , Patient Safety , Pyrrolidinones/adverse effects , Triamcinolone/therapeutic use , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Drug Interactions , Eosinophilia/chemically induced , Exanthema/chemically induced , Female , Fever/chemically induced , HIV Infections/drug therapy , HIV Integrase Inhibitors/administration & dosage , Humans , Pyrrolidinones/administration & dosage , Raltegravir Potassium , Treatment OutcomeABSTRACT
BACKGROUND: Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-stage renal disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage renal disease. METHODS: We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline renal function, HIV parameters, renal pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors associated with adverse renal outcome were identified. RESULTS: From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without renal disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage renal disease. There were no significant differences in renal function and HIV parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of HIV RNA suppression between the 20 patients who developed end-stage renal disease >3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable renal function. However, the index of chronic damage score was significantly higher in those who developed end-stage renal disease (P < .001), and an index of chronic damage score >75 was associated with shorter renal survival (P < .001). CONCLUSIONS: Whereas overall patient survival suggested an important benefit of highly active antiretroviral therapy, no additional renal benefit of early initiation of highly active antiretroviral therapy or viral suppression could be demonstrated in this large cohort of patients with established HIVAN. Severity of chronic kidney damage, as quantified by biopsy, was the strongest predictor of renal outcome.
Subject(s)
AIDS-Associated Nephropathy/diagnosis , Kidney/pathology , AIDS-Associated Nephropathy/drug therapy , AIDS-Associated Nephropathy/ethnology , Adult , Antiretroviral Therapy, Highly Active/adverse effects , Black People/statistics & numerical data , Female , Humans , Kidney/drug effects , Kidney Failure, Chronic/ethnology , Kidney Failure, Chronic/etiology , Male , Prognosis , Retrospective Studies , Time Factors , United Kingdom/epidemiologyABSTRACT
Zidovudine monotherapy is used to reduce perinatal HIV transmission in women with low viral loads. There are few data on the risk of drug resistance in this select cohort of women. We determined the prevalence of newly acquired mutations conferring reduced sensitivity to zidovudine after exposure during pregnancy, and found that the development of mutations was uncommon and was restricted to women treated before 1998 who had higher baseline viral loads than those currently recommended monotherapy.
