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To the Editor: Updated guidelines for the use of antiretroviral agents in human immunodeficiency virus (HIV)–infected patients give preference to regimens including 2 nucleoside analogs and 1 protease inhibitor.¹ Unlike nucleoside analogs, protease inhibitors are potent inhibitors of the cytochrome P450 of the liver, resulting in a propensity for drug-drug interaction. Ergotism related to concurrent administration of ergotamine tartrate and ritonavir recently has been reported.² Here, we report the first case, to our knowledge, of ergotism in a patient receiving antiretroviral treatment with indinavir for whom ergotamine tartrate therapy was recently begun.

Report of a Case.

A 30-year-old homosexual man had been infected with HIV since May 1990 but had no previous opportunistic infection. The CD4 cell count was 0.19 x 10⁹/L and plasma HIV RNA was 1500 copies/mL; hepatic and renal function were normal. The patient had been receiving lamivudine, 300 mg/d; stavudine, 60 mg/d; indinavir, 2400 mg/d; and trimethoprim-sulfamethoxazole for Pneumocystis . . . [Full Text of this Article]

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