Alopecia induced by lopinavir plus ritonavir therapy in an HIV patient

J Drugs Dermatol. 2007 Jul;6(7):742-3.

Abstract

The most commonly reported side effects related to lopinavir/ritonavir are diarrhea, vomiting, headache, nausea, and increased serum triglycerides and cholesterol levels. About 4% of the patients prescribed lopinavir/ritonavir stop taking it because of side effects. Alopecia, generally involving the scalp, has been reported in patients with HIV infection treated with indinavir but not with lopinavir/ritonavir. We present a 62-year-old man with HIV infection, stage B2, who experienced alopecia totalis of his scalp, eyebrows, and eyelashes beginning 18 months after initiating antiretroviral treatment including lopinavir/ritonavir. No hair loss on the arms, legs, and pubic area was observed. Our patient's drug regimen consisted of lopinavir/ritonavir, efavirenz, and stavudine; in addition, the patient was receiving treatment for diabetes with glivenclamide and metformin for the last 3 years. These drugs have not been shown to cause alopecia. Alopecia reversed completely 2 months after substituting nelfinavir for lopinavir/ritonavir without any other change of treatment and his eyelashes and eyebrows grew back as well. To our knowledge, this is the second case of lopinavir/ritonavir-associated alopecia totalis reported in the international literature.

Publication types

  • Case Reports

MeSH terms

  • Alopecia / chemically induced*
  • Alopecia / prevention & control
  • Antiretroviral Therapy, Highly Active / adverse effects
  • HIV Infections / drug therapy
  • Humans
  • Lopinavir
  • Male
  • Middle Aged
  • Nelfinavir / therapeutic use
  • Pyrimidinones / adverse effects*
  • Pyrimidinones / therapeutic use
  • Ritonavir / adverse effects*
  • Ritonavir / therapeutic use
  • Treatment Outcome

Substances

  • Pyrimidinones
  • Lopinavir
  • Nelfinavir
  • Ritonavir