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Abstract：
With the improving life expectancy of patients with human immunodeficiency virus (HIV), there is an increasing health concern of potential toxicity and drug interactions of long-term antiretroviral therapies. We describe a female patient with HIV, who was admitted to the emergency department following an unexplained loss of consciousness. This patient had been on antiretroviral therapy comprising tenofovir disoproxil fumarate, lamivudine, and lopinavir/ritonavir for 12 years. Coincidentally, she had been prescribed terfenadine for urticaria recently. After 3 days on this medication, she suddenly lost her consciousness, with a distinctive electrocardiogram alteration characterized by QT prolongation and torsade de pointes. This symptom recurred several times over a span of 2 days. We postulate that the primary instigator was an elevated concentration of terfenadine, which can be traced back to her antiretroviral therapy regimen comprising lopinavir/ritonavir. This drug is known to impede the metabolism of cytochrome P450 3A4 substrates and consequently elevate terfenadine concentrations.
摘要：
随着人类免疫缺陷病毒（HIV）患者预期寿命的提高，长期抗逆转录病毒疗法的潜在毒性和药物相互作用越来越引起健康关注.我们描述了一个感染艾滋病毒的女性患者，他因无法解释的失去知觉而被送往急诊室。该患者一直在接受抗逆转录病毒治疗，包括富马酸替诺福韦酯，拉米夫定,洛匹那韦/利托那韦已经12年了.巧合的是,她最近服用了特非那定治疗荨麻疹。在服用这种药物3天后，她突然失去了知觉,以QT延长和尖端扭转为特征的独特心电图改变。这种症状在2天内多次复发。我们假设主要的兴奋剂是特非那定的浓度升高，这可以追溯到她的抗逆转录病毒治疗方案，包括洛匹那韦/利托那韦。已知这种药物会阻碍细胞色素P4503A4底物的代谢，从而提高特非那定的浓度。
