On Tuesday, February 23, the Food and Drug Administration issued a warning about the potential of life-threatening heart risks when combining two common HIV drugs. Both of these drugs, Saquinavir (Inverase) and Ritonavir (Norvir) are protease inhibitors and when used together have been demonstrated to lead to sudden death from a condition known as Cardiac Autonomic Neuropathy (CAN).
As many of you are aware, I have been testing for this over the last year within our office. Many patients have been discovered to have CAN and treatment with a simple, inexpensive medication can re-stabilize the autonomic nervous system and reverse this high risk of sudden cardiac death.
I would like all my HIV patients who are on Protease Inhibitors to have their autonomic testing repeated if your last test was greater than 6 months ago (prior to August 1, 2009). I am presently evaluating a new treatment strategy for all patients on protease inhibitor as to whether or not we will continue these or will simply need to discontinue the Ritonavir (Norvir).
The following is a listing of all the protease inhibitors in use. Check your medications lists located on the bottom of your office visit notes to check if your are on one of these medications. If so, you need to have your autonomic function rechecked.
Brand Name Generic Name
Kaletra lopinavir + ritonavir
For the time being, do not discontinue you medications, just call the office (816-756-0090) and get scheduled to have your autonomic testing repeated so we can quickly identify those individuals with CAN and get them stabilized with medication.
In the meantime, I am already working out with other clinicians and researchers to determine what is the best course of action for those of you on protease inhibitors.