Tenofovir/ddI interaction: pancreatitis death highlights risk

Keith Alcorn
Estimated reading time 1 minutes
This article is more than 21 years old.

A report from a Welsh clinic shows that the combination of tenofovir and ddI must be handled with care. Doctors reported to the Sixth International Congress on Drug Therapy in HIV Infection in Glasgow a case of fatal acute pancreatitis in a 47 year old man in a man receiving salvage therapy with tenofovir, d4T and ddI. The patient commenced the regimen in December 2001, and in January 2001 amylase levels were normal.

However, less than a month later the patient was admitted to hospital with nausea, vomiting and abdominal pain, and was found to have an amylase level of 3972 units/l.

Antiretroviral therapy was ceased and the patient died less than a month later from acute respiratory distress syndrome (ARDS), a complication of pancreatitis.

Glossary

pancreatitis

Inflammation of the pancreas.

salvage therapy

Any treatment regimen used after a number of earlier regimens have failed. People with HIV who have experienced side-effects and/or developed resistance to many HIV drugs receive salvage therapy, sometimes consisting of a large number of medications.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

amylase

An enzyme produced in the pancreas and saliva which assists in the digestion of starch.

abdomen

The part of the body below the chest, including the stomach, liver, intestines, kidneys, bladder, ovaries and uterus. The word ‘abdominal’ relates to pain or other problems in that area.

See Pancreatitis in the A to Z of illnesses on this site for further details.

The same group also reported four cases of symptomatic hyperlactatemia, two of which occurred in patients receiving ddI/d4T in combination with tenofovir.

The manufacturers of both ddI and tenofovir have recommended caution in the combination of ddI and tenofovir due to evidence that tenofovir increases ddI levels. Click here for full details of the study.

References

Davies L et al. Fatal acute pancreatitis in an HIV-positive man – the result of an interaction between tenofovir disproxil fumarate (TDF) and didanosine (ddI). Sixth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P124, 2002.

Yoganathan K et al. Symptomatic hyperlactatemia – four case reports. Sixth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P126, 2002..

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