Iatrogenic Osteoporosis, Bilateral Hip Osteonecrosis, and Secondary Adrenal Suppression in an Hiv-Infected Man Receiving Inhaled Corticosteroids and Ritonavir-Boosted Highly Active Antiretroviral Therapy

Comorbidities impact a large proportion of patients with chronic obstructive pulmonary disease (COPD), with over 80% of patients with COPD estimated to have at least one comorbid chronic condition. Guidelines for the treatment of COPD are just now incorporating comorbidities to their management recommendations of COPD, and it is becoming increasingly clear that multimorbidity as well as specific comorbidities have strong associations with mortality and clinical outcomes in COPD, including dyspnea, exercise capacity, quality of life, healthcare utilization, and exacerbation risk. Appropriately, there has been an increased focus upon describing the burden of comorbidity in the COPD population and incorporating this information into existing efforts to better understand the clinical and phenotypic heterogeneity of this group. In this article, we summarize existing knowledge about comorbidity burden and specific comorbidities in COPD, focusing on prevalence estimates, association with outcomes, and existing knowledge about treatment strategies.

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“…This is doubly important given the emerging evidence for serious interactions between some antiretroviral agents and some types of ICS. 203,204…”

Section: Chronic Obstructive Pulmonary Disease and Hiv/aidsmentioning

confidence: 99%

Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management

Putcha

Drummond

Wise

et al. 2015

Semin Respir Crit Care Med

146

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“…By searching PubMed and the references of pertinent articles, and by contacting relevant drug companies, we identified 51 case reports published in English regarding adverse effects with the use of inhaled ( n = 45), intranasal ( n = 2), and combination inhaled and intranasal ( n = 4) corticosteroids and PIs (Table ) . Papers were published between the years 1999 and 2012.…”

Section: Case Reports On Corticosteroid−protease Inhibitor Drug−drug mentioning

confidence: 99%

“…Fluticasone was used by both the patients on intranasal corticosteroids . In the four cases of combined inhaled and intranasal corticosteroid use, one patient used inhaled and intranasal budesonide , one used inhaled fluticasone and intranasal mometasone , one used inhaled beclomethasone and nasal fluticasone , and one used inhaled and intranasal fluticasone . The mean daily dose of inhaled fluticasone in the paediatric population was 343 μg/day (range 50−1000 μg/day) and that in adults was approximately 841 μg/day (range 200−2000 μg/day).…”

Section: Case Reports On Corticosteroid−protease Inhibitor Drug−drug mentioning

confidence: 99%

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

2013

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Due to the inhibition of hepatic cytochrome P450 3A4 isozyme, HIV protease inhibitors can result in significant drug-drug interactions. One noteworthy interaction is between protease inhibitors and inhaled or intranasal corticosteroids. This interaction can result in adrenal insufficiency, iatrogenic Cushing’s syndrome (with symptoms such as rapid weight gain, obesity, facial hirsutism and swelling, etc.), as well as hypertension, osteoporosis, and decreased CD4+ cell count. In this paper, we review and unite pharmacokinetic data, case reports, and current research regarding this drug-drug interaction in order to provide options for the clinical management of HIV-positive patients requiring treatment with protease inhibitors and inhaled or intranasal corticosteroids.

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“…Karkoulias et al describe a case report of a 38-year-old male who developed bilateral femoral head osteonecrosis without any metabolic, coagulopathic, or lifestyle related risk factors but a long-term history of inhaled fluticasone propionate, intranasal triamcinolone acetonide, and intermittent oral corticosteroids for chronic asthma [7]. Kaviani et al describe another case of bilateral hip osteonecrosis in a patient receiving inhaled corticosteroids, but this patient also was infected with HIV and on antiretroviral therapy [8]. …”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids

Egger

Ballock

2017

Case Reports in Pediatrics

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A relationship between the development of osteonecrosis of the femoral head and systemic corticosteroids has been well established in the literature, particularly in adults. However, the link between osteonecrosis and inhaled corticosteroids is less researched and understood. We report an usual case report of a 10-year-old male who developed ipsilateral femoral head osteonecrosis after long-term inhalational corticosteroid and intermittent short courses of oral steroid usage with a unique presentation and delayed diagnosis.

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Iatrogenic Osteoporosis, Bilateral Hip Osteonecrosis, and Secondary Adrenal Suppression in an Hiv-Infected Man Receiving Inhaled Corticosteroids and Ritonavir-Boosted Highly Active Antiretroviral Therapy

Cited by 26 publications

References 12 publications

Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management

Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids

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