Case 5: Antiretrovirals and Statins

You answered:

	The patient's clinical presentation most likely resulted from simvastatin-induced increases in levels of darunavir, thereby causin hepatic and renal toxicity.

This answer is incorrect. Simvastatin is not known to impact darunavir levels and darunavir does not cause nephrotoxcity.

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