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Cardiology - Clinical Cardiology
A 53-year-old woman with HIV/hepatitis C virus (HCV) co-infection, pulmonary arterial hypertension (PAH), and end-stage renal disease (ESRD) had been receiving high-flux haemodialysis three times weekly since 2014. Her PAH treatment consisted of bosentan 125 mg twice daily and tadalafil 20 mg once daily. Antiretroviral therapy included darunavir/cobicistat 800/150 mg once daily.
After reintroduction of bosentan and tadalafil following HCV treatment, she developed recurrent episodes of congestive heart failure and was subsequently admitted with severe respiratory failure and clinical features of decompensated heart failure. Despite daily haemodialysis and increased fluid removal, her clinical response was poorer than expected. At the same admission, HIV-1 RNA was 5424 copies/mL, with a new integrase resistance mutation.
Bosentan toxicity related to a potential drug–drug interaction with darunavir/cobicistat was suspected. Bosentan was therefore discontinued, and an alternative endothelin receptor antagonist was considered. The patient was switched to ambrisentan, while antiretroviral therapy was optimized.
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