A 68-year old male presenting with rhabdomyolysis-associated acute kidney injury following concomitant use of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate and pravastatin/fenofibrate: a case report.
BACKGROUND
We present what we believe to be the first case in the literature of rhabdomyolysis-induced renal failure caused by a probable drug interaction between elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF) and pravastatin/fenofibrate.


METHODS
A 68-year old Caucasian man presented with progressive pain in both legs two weeks after commencing treatment with EVG/COBI/FTC/TDF. He was found to have biochemical evidence of rhabdomyolysis and acute renal failure.


CONCLUSIONS
We emphasize the need for post marketing surveillance of adverse effects of new products. Pharmacokinetic studies are necessary to investigate the levels of pravastatin in patients taking COBI and fenofibrate with and without other comorbidities. Meanwhile, we suggest that creatine kinase levels should be monitored and patients advised to report myalgias when using concomitant EVG/COBI/FTC/TDF and pravastatin/fenofibrate. This case serves as an important reminder to use estimated glomerular filtration rates rather than serum creatinine levels when choosing new medications. If potentially nephrotoxic combinations are started in patients with borderline estimated glomerular filtration rates, it may be prudent to check these filtration rates more frequently than usual. In patients with reduced estimated glomerular filtration rates, potentially nephrotoxic combinations should be avoided wherever possible.
Tropical Disease Unit, Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium. veronique.suttels@outlook.com.
Veronique
V
Suttels
Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43/3, 2000, Antwerp, Belgium. eflorence@itg.be.
Eric
E
Florence
Department of Pharmacy, Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium. john.leys@uza.be.
John
J
Leys
Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43/3, 2000, Antwerp, Belgium. mvekemans@itg.be.
Marc
M
Vekemans
Tropical Disease Unit, Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium. jvdende@itg.be.|Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43/3, 2000, Antwerp, Belgium. jvdende@itg.be.
Jef
J
Van den Ende
Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43/3, 2000, Antwerp, Belgium. evlieghe@itg.be.
Erika
E
Vlieghe
Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43/3, 2000, Antwerp, Belgium. ckenyon@itg.be.
Chris
C
Kenyon
D058186:Acute Kidney Injury / Q000150:complications* / Q000209:etiology; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000924:Anticholesteremic Agents / Q000009:adverse effects; D004347:Drug Interactions; D000069545:Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination / Q000009:adverse effects*; D011345:Fenofibrate / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects; D008297:Male; D017035:Pravastatin / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced*
D019380:Anti-HIV Agents; D000924:Anticholesteremic Agents; D000069545:Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; D000960:Hypolipidemic Agents; D017035:Pravastatin; D011345:Fenofibrate