Fehmida Visnegarwala, MD; Kurt L. Krause, MD, PhD; Daniel M. Musher, MD
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Visnegarwala F., Krause K., Musher D.; Severe Diabetes Associated with Protease Inhibitor Therapy. Ann Intern Med. 1997;127:947. doi: 10.7326/0003-4819-127-10-199711150-00016
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Published: Ann Intern Med. 1997;127(10):947.
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 2 diabetes, but the patient was repeatedly euglycemic (Figure 1).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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