HIV and ID Observations

April 24th, 2009

Colonoscopy in HIV Patients, Part II: Problem (Mostly) Solved

Both here and on the AIDS Clinical Care site, we posted a case of a 50-year-old HIV+ man in need of a screening colonoscopy.  What sedation could he receive while on tenofovir/FTC and ritonavir-boosted atazanavir?  Specifically, would midazolam and fentanyl (“contraindicated” in the ritonavir package insert) be ok? (Same issue for efavirenz, by the way.) We solicited […]

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March 1st, 2009

Sedation for Colonoscopies in HIV Patients: Debate Rages

Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story — or “consider […]

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