© 2000 BMJ Publishing Group
Letter to the editor
Cheilitis in association with indinavir
Departments of HIV medicine and Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH
Correspondence to:
Dr Fox
Accepted June 19, 2000
EDITOR,—There is increasing speculation that indinavir may cause side effects which have been previously associated with high concentrations of retinoids. In the presence of all-trans-retinoic acid (ATRA), indinavir, but not other protease inhibitors (PIs), alters stem cell differentiation in vitro, not seen in the presence of ATRA alone.1 Alopecia and cheilitis are two side effects associated with both retinoids and the protease inhibitor indinavir (but not with any of the other protease inhibitors). These side effects can be reversed on changing from indinavir to an alternative PI.2 We report a case of cheilitis associated with indinavir which resolved rapidly on changing treatment.
A 35 year old African man developed cheilitis (fig 1A) 5 months after commencing HAART with stavudine, lamivudine, and indinavir. His CD4 lymphocyte count at that time was 238 cells x106/l, with an HIV viral load of 78 copies per ml (Chiron bDNA assay
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