A report from a Welsh clinic shows that the combination of tenofovir and ddI must be handled with care. Doctors reported to the Sixth International Congress on Drug Therapy in HIV Infection in Glasgow a case of fatal acute pancreatitis in a 47 year old man in a man receiving salvage therapy with tenofovir, d4T and ddI. The patient commenced the regimen in December 2001, and in January 2001 amylase levels were normal.
However, less than a month later the patient was admitted to hospital with nausea, vomiting and abdominal pain, and was found to have an amylase level of 3972 units/l.
Antiretroviral therapy was ceased and the patient died less than a month later from acute respiratory distress syndrome (ARDS), a complication of pancreatitis.
See Pancreatitis in the A to Z of illnesses on this site for further details.
The same group also reported four cases of symptomatic hyperlactatemia, two of which occurred in patients receiving ddI/d4T in combination with tenofovir.
The manufacturers of both ddI and tenofovir have recommended caution in the combination of ddI and tenofovir due to evidence that tenofovir increases ddI levels.
References
Davies L et al. Fatal acute pancreatitis in an HIV-positive man – the result of an interaction between tenofovir disproxil fumarate (TDF) and didanosine (ddI). Sixth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P124, 2002.
Yoganathan K et al. Symptomatic hyperlactatemia – four case reports. Sixth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P126, 2002..