- Researchers in Delaware warn that severe cases of ingrown toenails have been observed in HIV patients treated with indinavir (IDV) and ritonavir (RTV).
Dr. Christopher W. James and colleagues working with Christiana Care Health Services' Community HIV Program described their experience with this side effect in the Annals of Pharmacotherapy.
Ingrown nails and the accompanying inflammation are exacerbated in patients infected with HIV and often require surgery for resolution, they said.
The researchers described five cases of ingrown toenails with paronychia, or inflammation of tissue around the nail. Although all patients required surgery to deal with this condition, which often involved multiple digits and became recurrent in two patients, they found that most decided to continue therapy in order to maintain successful viral control.
The development of ingrown toenails was a known effect of other regimens containing indinavir, which heightens retinoic acid signaling, according to James and coauthors. However, the risk may be higher in patients combining the drug with ritonavir, which boosts indinavir levels and prolongs its effects.
The median time to ingrown toenail development in the patients studied was 18.4 weeks after therapy initiation ("Recurrent ingrown toenails secondary to indinavir/ritonavir combination therapy," Ann Pharmacother 2001 Jul;35(7-8):881-884.
"With the increasing popularity of IDV/RTV combination therapy, clinicians should be aware of the potential increase in frequency of dose-related toxicities including IGTN [ingrown toenails]," James and colleagues concluded. "Evaluation of hands and feet on physical examination should be recommended for all patients being treated with lamivudine and IDV, especially when used in combination with RTV."
The corresponding author for this report is Christopher W. James, Doctor of Pharmacy, Christiana Care Health Services, HIV Community Program, 501 W. 14th St., Wilmington, DE 19801, USA.
A search at www.NewsRx.net using the search term "AIDS and HIV therapy" yielded 1,191 articles in six specialized reports.
Key points reported in this study include:
- Severe cases of ingrown toenails have been seen in HIV patients taking indinavir with ritonavir
- Affected patients are likely to develop this condition in multiple digits and often require surgical resolution
- While this side effect has been reported in patients treated with other indinavir based regimens, ritonavir enhancement of indinavir levels may increase risk
This article was prepared by AIDS Weekly editors from staff and other reports.