A 33-year-old homeless man is hospitalized due to recent weight loss, odynophagia, and progressive cough. He is found to be HIV-positive and his CD4 count is 45/mm³. The patient's condition improves on a newly instituted treatment, but 4 weeks later at outpatient follow-up he is found to have significantly elevated fasting blood glucose. Which of the following medications is most likely responsible for his hyperglycemia?

Question

Quizplus · Accepted Answer

11ec160b_3bf1_b3f3_9249_3710924bc225_MD0001_00 Lopinavir is a protease inhibitor (PI). These drugs reversibly inhibit viral protease, an enzyme responsible for HIV polyprotein cleavage to form mature viral proteins. PIs are never used as monotherapy as viral resistance to the entire class can form quickly. The following important adverse effects can be seen with PIs: (Choice A) Acyclovir is an antiviral drug active against herpes simplex virus types 1 and 2 and varicella-zoster viruses. Renal toxicity is the most important side effect. (Choice C) Azithromycin is a macrolide antibiotic used for treatment and prophylaxis of Mycobacterium avium complex infections in patients with HIV. (Choice D) Foscarnet is used for the treatment of cytomegalovirus infections. It may cause nephrotoxicity and electrolyte disturbances (eg, hypocalcemia, hypomagnesemia, hypokalemia). (Choice E) Trimethoprim-sulfamethoxazole (TMP-SMX) is used in patients with HIV for the prevention and treatment of pneumonia caused by Pneumocystis jirovecii (formerly P carinii). The most important side effects associated with TMP-SMX are megaloblastic anemia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. (Choice F) Zidovudine is a nucleoside reverse transcriptase inhibitor (NRTI). NRTIs act by suppressing DNA synthesis from viral RNA. One of the most common side effects of zidovudine is bone marrow toxicity, resulting in anemia in up to 40% of patients. Educational objective: Protease inhibitors are HIV antiretroviral medications that inhibit cleavage of the polypeptide precursor into mature viral proteins. Their side effects as a class include hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450.

A 33-Year-Old Homeless Man Is Hospitalized Due to Recent Weight