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Case 5: Antiretrovirals and Statins

You answered:

A The patient's clinical presentation most likely resulted from simvastatin-induced increases in levels of trimethoprim-sulfamethoxazole, which caused hepatic and renal toxicity.

This answer is incorrect. Simvastatin does not have a significant drug-drug interaction with trimethoprim-sulfamethoxazole.

Choose another answer:

B Abacavir likely caused a marked increase in the intracellular levels of simvastatin, triggering statin-induced acute rhabdomyolysis and renal failure. This combination of abacavir and a statin drug should be avoided in all patients.
C The patient's clinical presentation most likely resulted from simvastatin-induced increases in levels of darunavir, thereby causin hepatic and renal toxicity.
D The patient's clinical presentation is best explained by drug-induced rhabdomyolysis and acute renal failure caused by elevated plasma levels of simvastatin. The increased simvastatin levels resulted from co-administration of simvastatin with ritonavir-boosted darunavir.

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