Clinical

Rhabdomyolysis complicates multidrug treatment of HIV-infected patient

Last Updated: 2003-06-25 6:00:04 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - An HIV-infected patient receiving treatment for HIV-related dyslipidemia and lobar pneumonia developed rhabdomyolysis as a result of the drug treatment, according to a report in the May issue of AIDS Patient Care and STDs.

Rhabdomyolysis has been reported in patients taking statins alone or in combination with other myotoxic agents or with drugs that elevate statin concentrations into the toxic range, the authors note.

Jinell Mah Ming and Dr. John Gill from Southern Alberta HIV Clinic in Calgary, Alberta, Canada, report a case of rhabdomyolysis that likely resulted from a CYP3A4 drug interaction after the concurrent use of clarithromycin to treat lobar pneumonia, atorvastatin to treat HIV-related dyslipidemia, and lopinavir/ritonavir to treat the HIV infection.

The 34-year-old male AIDS patient, whose course was also complicated by liver disease, developed sharp muscle pains and episodic sensory and motor loss eight days after beginning a course of clarithromycin as treatment for a community-acquired acute lobar pneumonia.

The patient's creatine kinase concentration reached 11,332 U/L, the authors report, and his urine was positive for myoglobin. ALT, ALP, and total bilirubin were also markedly elevated.

The patient received an alkaline diuresis, the report indicates, and his creatine kinase levels decreased to normal by day 7 after treatment.

"The administration of lopinavir/ritonavir and then clarithromycin, which both strongly inhibit the CYP3A4 isoenzyme, likely elevated plasma concentrations of atorvastatin," the investigators explain. "Rhabdomyolysis resolved when both agents were discontinued."

"HIV-infected patients need to communicate to all their healthcare providers their health status and the multiple medications they may be taking," Ming told Reuters Health. "Patients who see specialists for each medical complication must realize that each specialist may not be aware of what other physicians are prescribing to them."

For their part, Ming said, physicians should be aware that when faced with various therapeutic choices, they should choose a drug that not only is effective, but that also won't complicate the patient's ongoing therapy.

"An ideal situation would be to monitor drug levels," Ming continued. However, determining what is "toxic" is difficult because of patient-to-patient intervariability. "Unknown therapeutic levels versus toxic levels is the greatest limitation," she concluded.

AIDS Patient Care STDs 2003;17:207-210.