Early neuropsychological adverse events after switching from PI/r to dolutegravir could be related to hyperthyroidism in patients under levothyroxine.
We report two patients who had taken levothyroxine at the same dose for several years and who had stable thyroid stimulating hormone (TSH) levels, and who developed clinical and biological hyperthyroidism following switch from ritonavir-boosted protease inhibitors (PIs) to dolutegravir-based HAART. Levothyroxine is metabolized by deiodination and glucuronidation and the induction of glucuronidation by ritonavir leads to an increased elimination of levothyroxine and a necessity of higher daily doses. Patients who switch from ritonavir-boosted PIs to antiretroviral drugs-based HAART with minimal drug-interaction such as dolutegravir, may require an adjustment in their dose of levothyroxine in order to prevent hyperthyroidism due to impaired elimination of levothyroxine without ritonavir.
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.
Jean-Luc
JL
Berger
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.|Faculty of Medicine, University of Reims Champagne-Ardenne, EA-4684, / SFR CAP-SANTE, Reims, France.
Yohan
Y
Nguyen
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.
Delphine
D
Lebrun
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.
Caroline
C
Migault
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.
Maxime
M
Hentzien
Department of Pharmacology and Toxicology, Reims University Hospital, 51095, Reims Cedex, France.
Hélène
H
Marty
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.|Faculty of Medicine, University of Reims Champagne-Ardenne, EA-4684, / SFR CAP-SANTE, Reims, France.
Firouzé
F
Bani-Sadr
D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D004347:Drug Interactions; D057915:Drug Substitution / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006575:Heterocyclic Compounds, 3-Ring / Q000009:adverse effects*; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D019438:Ritonavir / Q000627:therapeutic use; D013974:Thyroxine / Q000008:administration & dosage*; D000099226:Dolutegravir
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D006575:Heterocyclic Compounds, 3-Ring; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D019438:Ritonavir; D013974:Thyroxine; D000099226:Dolutegravir