Torsade de pointes associated with long-term antiretroviral drugs in a patient with HIV: a case report

Xuechun Mu; Yujiao Duan; Qiuhua Xu; Sa Wang; Guiju Gao; Ning Han; Hongxin Zhao

doi:10.3389/fphar.2023.1268597

Torsade de pointes associated with long-term antiretroviral drugs in a patient with HIV: a case report

Front Pharmacol. 2023 Oct 31:14:1268597. doi: 10.3389/fphar.2023.1268597. eCollection 2023.

Authors

Xuechun Mu¹, Yujiao Duan², Qiuhua Xu², Sa Wang², Guiju Gao², Ning Han^#², Hongxin Zhao^#²

Affiliations

¹ Emergency Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
² Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

With the improving life expectancy of patients with human immunodeficiency virus (HIV), there is an increasing health concern of potential toxicity and drug interactions of long-term antiretroviral therapies. We describe a female patient with HIV, who was admitted to the emergency department following an unexplained loss of consciousness. This patient had been on antiretroviral therapy comprising tenofovir disoproxil fumarate, lamivudine, and lopinavir/ritonavir for 12 years. Coincidentally, she had been prescribed terfenadine for urticaria recently. After 3 days on this medication, she suddenly lost her consciousness, with a distinctive electrocardiogram alteration characterized by QT prolongation and torsade de pointes. This symptom recurred several times over a span of 2 days. We postulate that the primary instigator was an elevated concentration of terfenadine, which can be traced back to her antiretroviral therapy regimen comprising lopinavir/ritonavir. This drug is known to impede the metabolism of cytochrome P450 3A4 substrates and consequently elevate terfenadine concentrations.

Keywords: QT prolongation; drug interaction; human immunodeficiency virus; lopinavir; ritonavir; terfenadine; torsades de pointes.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by a grant from the Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20191802) and a grant from the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX202126).