Case report of Triumeq (abacavir/dolutegravir/lamivudine) associated rhabdomyolysis in a human immunodeficiency virus (HIV) infected patient

Abstract

Rationale:With the existence of the human immunodeficiency virus (HIV) infection as a chronic disease, more often adverse effects of its treatment with the various antiretroviral therapies (ARTs) available have been recognized. Going further, Triumeq has been associated with a myriad of adverse effects, of which rhabdomyolysis is rarely reported in the literature.Patient concerns:The patient presented with muscle tenderness over the lower limbs and dark brown-to-red colored urine.Diagnosis:Given the presenting symptoms, as well as the laboratory testing, including elevated serum creatine kinase and liver enzymes, the diagnosis of rhabdomyolysis was made.Interventions:Improvement was achieved rapidly after starting intravenous fluid therapy and with discontinuation of Triumeq.OutcomesAfter discharge, repeated creatine kinase levels in the clinic have been normal and decision was made to initiate another ART and until now, no further episodes of rhabdomyolysis have developed. Regular outpatient follow-up has been ongoing for over 1 year and no complications have been identified.Lessons:This case aims to recognize rhabdomyolysis as a rare, but possible adverse effect associated with the use of Triumeq for HIV-infected patients and therefore clinicians prescribing this combination should be aware of this potential side effect and counsel their patients accordingly.

UK guideline for the use of HIV post‐exposure prophylaxis 2021

“…For darunavir, raltegravir and elvitegravir, there are sufficient data to be able to detect at least a 2-fold increase in risk of overall birth defects, and no such increases have been detected to date (APR accessed 09/01/2020). For tenofovir and FTC, there are sufficient data to detect at least a 1.5-fold increase in the risk of overall birth defects and a 2-fold increase in the risk of birth defects in the more common classes, cardiovascular and genitourinary systems; no such increases have been detected to date [141].…”

“…Myopathy or rhabdomyolysis has been reported with INSTIs [141, 142] and therefore caution should be taken in individuals with a history of myopathy or who are using other medicinal products associated with these conditions, for example statins [143].…”