Antiretrovirals
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Immune reconstitution syndrome (first report with fosamprenavir): 2 case reports Two patients developed immune reconstitution syndrome during treatment with lamivudine/zidovudine and nevirapine (patient 1), and tenofovir, lopinavir/ritonavir and fosamprenavir plus ritonavir (patient 2), for HIV infection. A 29-year-old woman (patient 1), who had Kaposi’s sarcoma, started HAART with lamivudine/zidovudine [Combivir] and nevirapine [dosages not stated]. Within 1 week, the lesions on her chin and left inner thigh had increased, for which she received radiotherapy. Within the next 8 weeks, she developed multiple lesions on her feet, trunk and legs, and prominent nodules on her cheek and left forearm. Biopsy findings confirmed Kaposi’s sarcoma. The size of some of her lesions had reduced, but she had gross lymphoedema on her mid thighs. The lesions on her feet had ulcerated, and she developed secondary infection, which limited her mobility. After receiving HAART for 11 weeks, she developed a single haemoptysis (2mL) episode along with minimal exertional dyspnoea, and was admitted. A CT scan revealed small volume mediastinal lymphadenopathy and pulmonary nodules bilaterally in her mid and lower zones. The findings were considered compatible with pulmonary Kaposi’s sarcoma. She started receiving liposomal doxorubicin with continuing radiotherapy. Within 1 week, her oedema improved. Chemotherapy was stopped after six cycles as her lesions had improved. A 38-year-old man (patient 2), who had plaque-stage Kaposi’s sarcoma along with lymphoedema up to his mid right calf, started HAART with tenofovir, lopinavir/ritonavir and fosamprenavir plus ritonavir [dosages not stated]. Within 4 weeks, he developed multiple new lesions on his thighs and chest wall; his lymphoedema had increased to affect both of his legs, which limited his mobility. He was hospitalised for mobilisation and pain control, and started receiving liposomal doxorubicin. Within 2 weeks, his lymphadenopathy improved. He was subsequently lost to follow-up. Author comment: "In these two cases, pre-existing [Kaposi’s sarcoma] which appeared to have an indolent course worsened significantly on starting HAART . . . Their clinical course is most likely due to [immune reconstitution syndrome]." Loke WC, et al. Timing of highly active antiretroviral therapy and chemotherapy for Kaposi’s sarcoma in patients with HIV infection. International Journal of STD 801049033 and AIDS 17: 565-566, No. 8, Aug 2006 - England
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of immune reconstitution syndrome associated with fosamprenavir. The WHO Adverse Drug Reactions database contained no report of immune system disorder associated with fosamprenavir.
0114-9954/10/1125-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Oct 2006 No. 1125
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