title: Recurrent ingrown toenails secondary to indinavir/ritonavir combination therapy.
abstract: OBJECTIVE
  To report five cases of ingrown toenails (IGTN) associated with indinavir/ritonavir (IDV/RTV) combination therapy.
  
  
  METHODS
  The median onset of IGTN from initiation of IDV/RTV therapy was 18.4 weeks. Four patients previously received IDV, with one of these experiencing prior IGTN. All patients required surgical management of IGTN. All patients received virologic benefit from ongoing antiretroviral therapy, and the majority of patients elected to maintain IDV/RTV combination therapy. Two patients experienced recurrent IGTN while receiving ongoing IDV/RTV combination therapy.
  
  
  CONCLUSIONS
  IGTN and paronychia have previously been reported with IDV and lamivudine. IGTN in patients with HIV infection is more likely to present acutely, involve more digits, and require surgical management IDV increases retinoic acid signaling and, based on elevated IDV concentrations from concomitant RTV therapy, the risk of IGTN may be increased in patients receiving IDV/RTV combination therapy.
  
  
  CONCLUSIONS
  With the increasing popularity of IDV/RTV combination therapy, clinicians should be aware of the potential increase in frequency of dose-related toxicities including IGTN. Evaluation of hands and feet on physical examination should be recommended for all patients being treated with lamivudine and IDV, especially when used in combination with RTV.
authors.affiliation: HIV Community Program, Christiana Care Health Services, Wilmington, DE 19801-1013, USA. cjames@christianacare.org
authors.forename: C W
authors.initials: CW
authors.lastname: James
authors.forename: K C
authors.initials: KC
authors.lastname: McNelis
authors.forename: D M
authors.initials: DM
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Szabo
authors.forename: A K
authors.initials: AK
authors.lastname: Bincsik
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D019469:Indinavir / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009263:Nails, Ingrown / Q000139:chemically induced* / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D019438:Ritonavir / Q000009:adverse effects*
chemical_list: D017320:HIV Protease Inhibitors; D019469:Indinavir; D019438:Ritonavir