Haemolytic anaemia associated with indinavir
- aDepartment of Pharmacology and Therapeutics, The University of Liverpool, Liverpool L69 3GE, UK, bDepartment of Genitourinary Medicine, Countess of Chester Hospital, Chester CH2 1UL, UK, cCSM Mersey Regional Monitoring Centre, Pharmacy Practice Unit, Liverpool L69 3GF, UK
- Dr M Pirmohamed, Department of Pharmacology and Therapeutics, The University of Liverpool, Ashton Street, Liverpool L69 3GE, UK
- Accepted 7 December 1998
Treatment for HIV infection is advancing rapidly. Many new drugs are becoming available and the life expectancy of diagnosed HIV patients has improved dramatically since the introduction of combination antiretroviral therapy. Protease inhibitors have been introduced recently; saquinavir, ritonavir, indinavir, and nelfinavir are currently available in the UK, and there are several new compounds entering the late phases of drug development. Their efficacy has been established,1 2 although less is known about their toxicity, particularly when used long-term. We report a case of severe haemolysis occurring after the initiation of indinavir therapy.
Figure Changes in haemoglobin level in relation to drug therapy
Case report
A 20-year-old man who was first diagnosed as being HIV positive in 1989 was referred to the Genitourinary Medicine Clinic in February 1994 with fatigue and oral candidiasis. He was treated with fluconazole. His CD4 count at the time was 310 cells/mm3. Over the next two years, the CD4 count showed a progressive decrease to below 200 cells/mm3. He refused antiretroviral therapy and prophylaxis for opportunistic infections.
In June 1996, the patient was admitted withPneumocystis carinii pneumonia (PCP) and labial herpes simplex which were treated with prednisolone, famciclovir and high-dose intravenous co-trimoxazole. He responded to the treatment and was discharged in July on PCP prophylaxis (co-trimoxazole 960 mg three times weekly). Antiretroviral therapy was again refused by the patient. The CD4+ count at the time of discharge was 77 cells/mm3, and the haemoglobin level ranged from 8.7 to 10.8 g/dl over the next 3 months.
In November 1996, the patient was again admitted to hospital unwell, lethargic and anorexic. He was on oral co-trimoxazole, fluconazole, valaciclovir, and stanozolol. The haemoglobin was 10.7 g/dl (see figure) and CD4+ count was <10 cells/mm3. At this time, the patient agreed …
