Related Experiment Videos
Exogenous cushing syndrome mimicking human immunodeficiency virus lipodystrophy
Samir K Gupta1, Michael P Dubé
1Division of Infectious Diseases, Indiana University School of Medicine, Wishard Memorial Hospital, Indianapolis, IN, 46202, USA. sgupta1@iupui.edu
Summary
A patient with human immunodeficiency virus (HIV) developed Cushing syndrome due to drug interactions, not lipodystrophy. This highlights the importance of considering medication side effects when diagnosing fat accumulation in HIV patients.
Area of Science:
- Endocrinology
- Pharmacology
- Infectious Diseases
Background:
- Human immunodeficiency virus (HIV) infection is often associated with lipodystrophy, characterized by abnormal fat accumulation.
- Protease inhibitors, like ritonavir, are crucial in managing HIV but can interact with other medications.
- Inhaled fluticasone is a common corticosteroid used for respiratory conditions.
Observation:
- A 45-year-old male with HIV presented with abnormal fat accumulation.
- Initial assessment suggested HIV lipodystrophy as the cause.
- Further evaluation revealed exogenous Cushing syndrome.
Findings:
- The patient's Cushing syndrome was linked to the interaction between ritonavir and inhaled fluticasone.
- Ritonavir inhibited the cytochrome P450 3A4 (CYP3A4) enzyme, reducing fluticasone metabolism.
- This led to increased systemic exposure to fluticasone, mimicking endogenous Cushing syndrome.
Implications:
- Clinicians must consider exogenous causes of Cushing syndrome, especially in patients with HIV on protease inhibitors.
- Abnormal fat accumulation may not always be due to HIV lipodystrophy.
- Caution is advised when prescribing inhaled fluticasone to patients receiving ritonavir due to potential drug interactions and adverse effects.