Doctors from Paris have described a case of severe muscle damage in an HIV-positive patient taking abacavir and the lipid-lowering drug ciprofibrate (Modalim). The case report was published in the 4th November edition of AIDS.
Although hypersensitivity to abacavir is known to occur in 5 to 8% of patients, this case raises fears that it may be aggravated by a drug commonly used to treat high blood fat levels – itself a side-effect of antiretroviral therapy. However, the report must be treated with caution as it only describes one patient’s experiences with these drugs.
The 48 year-old man had been taking ciprofibrate for almost three years. After a two-year treatment interruption, he began a triple nucleoside reverse transcriptase inhibitor (NRTI) combination of AZT (zidovudine), 3TC (lamivudine) and abacavir as Trizivir. He had previously taken two other antiretroviral drug regimens, both of which contained AZT and 3TC.
After eight days of Trizivir treatment, the man complained of fever, but continued to take his anti-HIV drug combination. Two days later, he had a temperature of 40°C, skin rash, high heart rate, high breathing rate, kidney failure, and evidence of damage to muscle and liver cells. There were no signs of infection.
He was treated in intensive care and both antiretroviral therapy and ciprofibrate were stopped. Although the markers of muscle damage increased over the next few days, the fever and skin rash disappeared after 48 hours.
Kidney failure resolved after 45 days.
“Severe rhabdomyolysis [muscle damage] has never been described during a hypersensitivity reaction to abacavir or during concomitant therapy with abacavir and a lipid-lowering drug,” the authors write.
“Special attention should be paid to signs of rhabdomyolysis when abacavir therapy is started in a patient who is already receiving a lipid-lowering drug,” they warn.
Fontaine C et al. Severe rhabdomyolysis during a hypersensitivity reaction to abacavir in a patient treated with ciprofibrate. AIDS 19: 1927-1928, 2005.