{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:10:40Z","timestamp":1783721440135,"version":"3.55.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007553","name":"Aids Fonds","doi-asserted-by":"publisher","award":["2014058"],"award-info":[{"award-number":["2014058"]}],"id":[{"id":"10.13039\/100007553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Clin Pharm"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Background<\/jats:italic> Inhaled or nasal corticosteroids can cause suppression of the hypothalamic\u2013pituitary\u2013adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. <jats:italic>Objective <\/jats:italic>To explore the adverse effect of hypothalamic\u2013pituitary\u2013adrenal suppression by local corticosteroids in HIV-infected patients. <jats:italic>Method <\/jats:italic>Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic\u2013pituitary\u2013adrenal axis was defined as a morning plasma cortisol below 80\u00a0nmol\/L or a cortisol below 550\u00a0nmol\/L during a 250 mcg adrenocorticotropic hormone-stimulation test. <jats:italic>Results <\/jats:italic>Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamic\u2013pituitary\u2013adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. <jats:italic>Conclusion <\/jats:italic>Hypothalamic\u2013pituitary\u2013adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4.<\/jats:p><jats:p><jats:italic>ClinicalTrials.gov Identifier<\/jats:italic> NCT02501486.<\/jats:p>","DOI":"10.1007\/s11096-020-00995-5","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T08:02:51Z","timestamp":1583395371000},"page":"347-350","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Hypothalamic\u2013pituitary\u2013adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients"],"prefix":"10.1007","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct02501486","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9735-8866","authenticated-orcid":false,"given":"Femke","family":"Besemer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Kramers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees","family":"Brinkman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad R. M. M.","family":"Hermus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonius E.","family":"van Herwaarden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"issue":"6","key":"995_CR1","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1210\/jc.2015-1218","volume":"100","author":"LH Broersen","year":"2015","unstructured":"Broersen LH, Pereira AM, Jorgensen JO, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. 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J Acquir Immune Defic Syndr. 2013;63(3):355\u201361.","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"995_CR8","doi-asserted-by":"publisher","first-page":"412","DOI":"10.7861\/clinmedicine.16-5-412","volume":"16","author":"ER Elliot","year":"2016","unstructured":"Elliot ER, Theodoraki A, Jain LR, Marshall NJ, Boffito M, Baldeweg SE, et al. Iatrogenic Cushing's syndrome due to drug interaction between glucocorticoids and the ritonavir or cobicistat containing HIV therapies. Clin Med (Lond). 2016;16(5):412\u20138.","journal-title":"Clin Med (Lond)"}],"container-title":["International Journal of Clinical Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-020-00995-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11096-020-00995-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-020-00995-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T16:12:44Z","timestamp":1628611964000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11096-020-00995-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,5]]},"references-count":8,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["995"],"URL":"https:\/\/doi.org\/10.1007\/s11096-020-00995-5","relation":{},"ISSN":["2210-7703","2210-7711"],"issn-type":[{"value":"2210-7703","type":"print"},{"value":"2210-7711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,5]]},"assertion":[{"value":"5 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"KB serves on advisory boards for Viiv, Gilead, MSD and Janssen. The other authors have no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}