ArticleClinical medicine (London, England)2016
Iatrogenic Cushing's syndrome due to drug interaction between glucocorticoids and the ritonavir or cobicistat containing HIV therapies.
Article in Clinical medicine (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 38 citations in OpenAlex.
- Low-Dose Hydrocortisone and Cognition in Women With HIV: A Randomized Clinical Trial.JAMA network open · 2026Trial
- Hypercortisolism: Causes, Consequences and Clinical Significance - A Review of Pathophysiology.Diabetes, obesity & metabolism · 2026Review
- Steroid Use, Adrenal Suppression, and Emergency Department Visits in COPD Patients: A Cross-Sectional StudyEndocrine, metabolic & immune disorders drug targets · 2026Observational
- Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History.Biomolecules · 2024Review
- Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy-Update 2022: Systematic Review.Pharmaceutics · 2023Review
- Real-World Evidence of the Top 100 Prescribed Drugs in the USA and Their Potential for Drug Interactions with Nirmatrelvir; Ritonavir.The AAPS journal · 2023Article
- Article
- Perioperative Evaluation and Management of Patients on Glucocorticoids.Journal of the Endocrine Society · 2022Review
- Multiple vertebral compression fractures in a human immunodeficiency virus-positive patient with glucocorticoid-induced Cushing syndrome treated with percutaneous vertebroplasty: a case report.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- What we have to know about corticosteroids use during Sars-Cov-2 infection.Journal of endocrinological investigation · 2021Review
- Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19.Frontiers in endocrinology · 2021Review
- Therapeutic effect of budesonide, montelukast and azithromycin on post-infectious bronchiolitis obliterans in children.Experimental and therapeutic medicine · 2020Article
- Guidance for the prevention and emergency management of adult patients with adrenal insufficiency.Clinical medicine (London, England) · 2020Article
- The challenge of HIV treatment in an era of polypharmacy.Journal of the International AIDS Society · 2020Review
- Iatrogenic Cushing's Syndrome Following Intra-Articular Triamcinolone Injection in an HIV-Infected Patient on Cobicistat Presenting as a Pulmonary Embolism: Case Report and Literature Review.International medical case reports journal · 2020Article
- Human Immunodeficiency Virus Infection and the Endocrine System.Endocrinology and metabolism (Seoul, Korea) · 2019Review
- HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management.American journal of clinical dermatology · 2019Review
- Triple therapy (ICS/LABA/LAMA) in COPD: thinking out of the box.ERJ open research · 2019Article
- Early Diagnosis of Latent Tuberculosis Reactivation due to Drug Interaction between Cobicistat and Intranasal Fluticasone.Case reports in infectious diseases · 2019Article
- IATROGENIC CUSHING SYNDROME IN AN HIV-INFECTED PATIENT SECONDARY TO CONCOMITANT THERAPY WITH GENVOYA AND EPIDURAL TRIAMCINOLONE.AACE clinical case reportsArticle
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ritonavir and cobicistat, used as pharmacokinetic enhancers in combination with some antiretrovirals (ARVs) for the treatment of HIV, are potent inhibitors of the CYP3A4 isoenzyme. Most glucocorticoids are metabolised via the CYP3A4 pathway and iatrogenic Cushing's syndrome (ICS), with possible secondary adrenal insufficiency (SAI), is a recognised complication following co-administration with ritonavir or cobicistat. A structured approach for identifying and managing potentially affected individuals has not been established.We systematically identified patients with ICS/SAI and found substantial heterogeneity in clinical practice across three large London HIV centres. While this significant drug interaction and its complications are now well-recognised, it is apparent that there is no standardised approach to management or guidance for the general physician. Here we describe the management of ICS/SAI in our current practice, review the available evidence and suggest practice recommendations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.