Severe Diabetes Associated with Protease Inhibitor Therapy
Authors: Fehmida Visnegarwala
Journal: Annals of Internal Medicine (1997)

Letters15 November 1997Severe Diabetes Associated with Protease Inhibitor TherapyFehmida Visnegarwala, MD, Kurt L. Krause, MD, PhD, and Daniel M. Musher, MDFehmida Visnegarwala, MDVeterans Affairs Medical Center; Houston, TX 77030-4211, Kurt L. Krause, MD, PhDVeterans Affairs Medical Center; Houston, TX 77030-4211, and Daniel M. Musher, MDVeterans Affairs Medical Center; Houston, TX 77030-4211Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-10-199711150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Protease inhibitors block the action of aspartate protease, which is required to produce new virions. We describe a patient in whom symptomatic hyperglycemia was associated with the protease inhibitor nelfinavir, perhaps as a result of inhibition of the protease that converts proinsulin to insulin.A 46-year-old man with advanced-stage AIDS was receiving didanosine and lamuvidine. His viral load was 380 000 RNA copies/mL, and his CD4+ count was 20 cells/mm3. Treatment was changed to nelfinavir, zidovudine, and lamivudine. Other medications were trimethoprim-sulfamethoxazole, ciprofloxacin, clarithromycin, ethambutol, itraconazole, megestrol acetate, phenytoin, amitryptyline, and carbamazepine. The patient's mother had type ...References1. Henry K, Rathgaber S, Sullivan C, McCabe K. Diabetes mellitus induced by megestrol acetate in a patient with AIDS and cachexia. Ann Intern Med. 1992; 116:53-4. Google Scholar2. Murray M, Lumpkin MD. FDA Public Health Advisory: Reports of Diabetes and Hyperglycemia in Patients Receiving Protease Inhibitors for the Treatment of Human Immunodeficiency Virus (HIV). Bethesda, MD: Food and Drug Administration: 1997. Google Scholar3. Tezapsidis N, Noctor S, Kannan R, Krieger TJ, Mende-Mueller L, Hook VY. Stimulation of "Prohormone Thiol Protease" (PTP) and [Met] encephalin by forskolin. J Biol Chem. 1995; 270:13285-90. Google Scholar4. O'Rahilly S, Gray H, Humphreys PJ, Krook A, Polonsky KS, White A, et al. Impaired processing of prohormones associated with abnormalities of glucose homeostasis and adrenal function. N Engl J Med. 1996; 333:1386-90. Google Scholar5. Cawley NX, Pu LP, Loh YP. Immunological identification and localization of yeast aspartic protease 3-like prohormone-processing enzymes in mammalian brain and pituitary. Endocrinology. 1996; 137:5135-43. Google Scholar Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Medical Center; Houston, TX 77030-4211 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDiabetes and HIVReversible diabetes mellitus induced by use of, and improved after discontinuation of, the antiretroviral medication zidovudine: a case reportFirst case of pancreas transplant alone in a patient with diabetes and HIV infectionImpaired glucose metabolism in HIV-infected pregnant women: a retrospective analysisNew-Onset Diabetes and Antiretroviral Treatments in HIV-Infected Adults in ThailandInfections virales et diabète en AfriqueMetabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in PregnancyHIV and diabetesNutrition and the HIV-associated lipodystrophy syndromeThe Burden of Diabetes and Hyperlipidemia in Treated HIV Infection and Approaches for Cardiometabolic CareAntiretroviral use during pregnancy for treatment or prophylaxisIssues of Prematurity and HIV InfectionPediatric antiretroviral therapyBoosting Dose Ritonavir Does Not Alter Peripheral Insulin Sensitivity in Healthy HIV-Seronegative VolunteersPremature onset of cardiovascular disease in HIV-infected individuals: the drugs and the virusEffect of HCV Infection on Glucose Metabolism in Pregnant Women with HIV Receiving HAARTHow sweet it is? 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Bricker, MDElevated resting energy expenditure among HIV-seropositive persons receiving highly active antiretroviral therapyInsulin Resistance in HIV Protease Inhibitor–Associated DiabetesAbnormal lipids and the acquired immunodeficiency syndrome: is there a problem and what should we do about it?New Developments in the Treatment of HIV Disease: An OverviewMetabolic abnormalities and body fat redistribution in HIV-1 infected patients: the lipodystrophy syndromeA Review of Protease Inhibitor-Induced HyperglycemiaProtease inhibitor-associated hyperinsulinaemiaDiabète sucré au cours des traitements par inhibiteurs des protéases chez le patient infecté par le VIHEarly experience with protease inhibitors in human immunodeficiency virus-infected childrenKetoacidosis associated with protease inhibitor therapyExacerbated Hyperglycemia Associated with NelfinavirNelfinavirPharmacologic Factors Affecting Glycemic Control 15 November 1997Volume 127, Issue 10Page: 947KeywordsAIDSGlucoseHyperglycemiaInsulinPancreatitisProhormonesProtease inhibitorsProteasesViral loadVision Issue Published: 15 November 1997 CopyrightCopyright © 1997 by American College of Physicians. 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