Journal of Antivirals & Antiretrovirals
Open Access

Abstract

Hydromorphone for Cancer Pain in HIV Patient: A Case Report

Daniel Madeira

Background: Antiretroviral therapy has been implicated in significant interactions with a variety of drug classes used to treat comorbid conditions in patients with HIV.

Case report: Male, under oral antiretroviral therapy (emtricitabine 200 mg+tenofovir diproxil fumarate 300 mg id, atazanavir 300 mg id, ritonavir 100 mg id) diagnosed with end-stage pancreatic cancer. Treated orally for pain with paracetamol 1 g 3id, metamizol 575 mg 2id and tramadol 100 mg 3id with poor analgesic control, a Numerical Pain Rating Scale=8. All the analgesic drugs prescribed were discontinued and started hydromorphone extended-release formulation 8 mg id per os with a reduction in the pain to Numerical Pain Rating Scale=0.

Discussion: There is a lack of precise scientific evidence to infer safety conclusions from the concomitant administration of hydromorphone and antiretroviral therapy. Limited existing studies suggest that there is no clinically significant interaction between either emtricitabine or tenofovir with hydromorphone. Regarding atazanavir and ritonavir, coadministration with hydromorphone has not been studied, they both induce glucuronidation and could decrease the opioid analgesic effect.

Conclusions: Since there is a lack of precise scientific evidence to infer safety conclusions from the concomitant administration of these drugs, more studies need to be performed.