{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:34:31Z","timestamp":1768908871464,"version":"3.49.0"},"reference-count":16,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215121001791_sec_a1\"><jats:title>Background<\/jats:title><jats:p>There are significant drug\u2013drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215121001791_sec_a2\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215121001791_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>A literature search and further cross-referencing yielded a total of seven reports on drug\u2013drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215121001791_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusion<\/jats:title><jats:p>The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215121001791","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T11:08:25Z","timestamp":1628852905000},"page":"755-758","source":"Crossref","is-referenced-by-count":7,"title":["Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature"],"prefix":"10.1017","volume":"135","author":[{"given":"N","family":"Seymour","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Richardson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J A","family":"McGilligan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"S0022215121001791_ref3","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-5-412"},{"key":"S0022215121001791_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000462"},{"key":"S0022215121001791_ref6","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12723"},{"key":"S0022215121001791_ref15","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000187444.38461.70"},{"key":"S0022215121001791_ref5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"S0022215121001791_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.hivar.2016.03.002"},{"key":"S0022215121001791_ref11","first-page":"452","article-title":"Mixed Cushing syndrome and adrenal insufficiency leading to increased deficit in CD4+ cell count in 2 HIV-infected patients treated by nasal fluticasone for chronic sinusitis","volume":"67","author":"Konopnicki","year":"2012","journal-title":"Acta Clinica Belgica"},{"key":"S0022215121001791_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199909100-00038"},{"key":"S0022215121001791_ref1","article-title":"Different types of intranasal steroids for chronic rhinosinusitis","volume":"4","author":"Chong","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215121001791_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2008.00579.x"},{"key":"S0022215121001791_ref4","unstructured":"4 HIV and AIDS: Brighton & Hove JSNA topic summary, December 2018. In: http:\/\/www.bhconnected.org.uk\/sites\/bhconnected\/files\/HIV%20JSNA%20topic%20summary%202018_0.pdf [25 June 2021]"},{"key":"S0022215121001791_ref14","unstructured":"14 Okasaki-Gutierrez, R , Poole, P , Troia-Concio, P , Asmuth, DM . Prevalence of subclinical iatrogenic Cushing's syndrome in patients being co-administered ritonavir and corticosteroids via inhaled, intranasal, and\/or topical route [abstract MOPE103]. Washington DC AIDS Conference, 2012"},{"key":"S0022215121001791_ref10","first-page":"112","article-title":"The importance of awareness of ritonavir\/cobicistat CYP 34A enzyme inhibition and its effect on steroid metabolism","volume":"186","author":"McDonnell","year":"2017","journal-title":"Ir J Med Sci"},{"key":"S0022215121001791_ref9","first-page":"68","article-title":"Intranasal mometasone as an alternative to fluticasone in an HIV patient on ritonavir","volume":"113","author":"Deol","year":"2014","journal-title":"Ann Allergy Asthma Immunol"},{"key":"S0022215121001791_ref16","doi-asserted-by":"publisher","DOI":"10.1177\/0897190016646510"},{"key":"S0022215121001791_ref2","unstructured":"2 BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update). In: https:\/\/www.bhiva.org\/HIV-1-treatment-guidelines [27 July 2020]"}],"container-title":["The Journal of Laryngology &amp; Otology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0022215121001791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T08:51:06Z","timestamp":1652345466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0022215121001791\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,13]]},"references-count":16,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["S0022215121001791"],"URL":"https:\/\/doi.org\/10.1017\/s0022215121001791","relation":{},"ISSN":["0022-2151","1748-5460"],"issn-type":[{"value":"0022-2151","type":"print"},{"value":"1748-5460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,13]]}}}