Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir-boosted darunavir

Int J STD AIDS. 2013 Sep;24(9):748-52. doi: 10.1177/0956462413480723. Epub 2013 Jul 8.

Abstract

Drug interactions involving human immunodeficiency virus protease inhibitors are common due to their inhibition of the cytochrome P450 3A4 isoenzyme. We describe the case of an HIV-infected patient treated with ritonavir-boosted darunavir who developed cushingoid features following an intra-articular injection of triamcinolone acetate. We review the probable mechanism for this interaction and describe similar cases of Cushing syndrome in patients receiving concomitant ritonavir and triamcinolone.

Keywords: AIDS; Cushing syndrome; HIV; HIV protease inhibitors; antiretrovirals; cobicistat; corticosteroids; drug interactions; ritonavir; toxicity; triamcinolone.

Publication types

  • Case Reports

MeSH terms

  • Cushing Syndrome / chemically induced*
  • Cushing Syndrome / diagnosis
  • Cushing Syndrome / drug therapy
  • Darunavir
  • Drug Interactions
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects*
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / therapeutic use
  • HIV-1
  • Humans
  • Iatrogenic Disease*
  • Injections, Intra-Articular / adverse effects
  • Middle Aged
  • Ritonavir / administration & dosage
  • Ritonavir / therapeutic use*
  • Shoulder Pain / drug therapy*
  • Sulfonamides / administration & dosage
  • Sulfonamides / therapeutic use*
  • Treatment Outcome
  • Triamcinolone / administration & dosage
  • Triamcinolone / adverse effects*

Substances

  • Glucocorticoids
  • HIV Protease Inhibitors
  • Sulfonamides
  • Triamcinolone
  • Ritonavir
  • Darunavir