title: [Iatrogenic adrenal insufficiency secondary to an interaction between ritonavir and inhaled fluticasone. A review of the literature].
abstract: BACKGROUND
  Highly effective antiretroviral treatment has improved the life expectancy of human immunodeficiency virus (HIV) infected patients, but has led to an increase in the comorbidities related to aging, such as the chronic obstructive pulmonary disease (COPD). All this implies the need for a greater number of drugs and an increasing risk of drugs interactions with antiretroviral treatment, particularly protease inhibitors.
  
  
  METHODS
  We report a case of iatrogenic adrenal insufficiency interaction secondary to ritonavir and inhaled fluticasone in an HIV-infected patient with COPD. A review was made of the cases reported in adults in the medical literature (Medline) up to December 2012.
  
  
  RESULTS
  A total of 34 cases were reported. The mean age was 4 years. The mean dose of ritonavir was 187 mg/day, while the fluticasone dose was 866 μg/day. The average time of the interaction between ritonavir and fluticasone was 8 months. In 85% of cases fluticasone was discontinued at the time of diagnosis of adrenal insufficiency/Cushing syndrome. Almost all (90%) patients had a complete resolution of the symptoms after changing the treatment.
  
  
  CONCLUSIONS
  HIV-infected patients on antiretroviral therapy with protease inhibitor boosted with ritonavir which requires the use of inhaled corticosteroids, beclomethasone would be the best treatment option.
authors: Servicio de Medicina Interna, Hospital San Pedro, Logroño, La Rioja, España. Electronic address: jmgomez@riojasalud.es.
authors: Juan Manuel
authors: JM
authors: Gómez-Cerquera
authors: Servicio de Neumología, Hospital San Pedro, Logroño, La Rioja, España.
authors: Elena
authors: E
authors: Hernando-López
authors: Departamento de Enfermedades Infecciosas, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, La Rioja, España.
authors: José Ramón
authors: JR
authors: Blanco-Ramos
mesh_terms: D000280:Administration, Inhalation; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D003480:Cushing Syndrome / Q000139:chemically induced*; D004347:Drug Interactions; D000068298:Fluticasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D019438:Ritonavir / Q000009:adverse effects* / Q000494:pharmacology
chemical_list: D001993:Bronchodilator Agents; D017320:HIV Protease Inhibitors; D000068298:Fluticasone; D019438:Ritonavir
keywords: Adrenal insufficiency; Cushing; Fluticasona; Fluticasone; Insuficiencia suprarrenal; Ritonavir