Atazanavir-associated menorrhagia

Abstract

Sir: Atazanavir (ATV) is a protease inhibitor (PI), which has similar action to older PIs and is thought to have fewer adverse effects. This is the first report of menorrhagia associated with ATV. A 39-year-old, HIV-infected woman since 1988 experienced menorrhagia a few days after starting ATV in combination with abacavir (ABC) and didanosine (DDI). The patient had CD4 count 214/mL and viral load 5046 copies/mL and was prescribed ATV 200 mg, ABC and DDI. Her previous antiretroviral regimens, zidovudine/ lamivudine and nevirapine, were discontinued because of immunological failure. The antiretroviral drugs that had been tried in the past, such as ABC, DDI, lamivudine, indinavir and stavudine, had been discontinued primarily because of adverse effects (lipodystrophy, migraine, dizziness). None of these agents had caused menstrual changes. Menarche had occurred at the age of 10 years, and her periods were regular. She has been having mild bleeding lasting for 4-5 days and occurring at three weeks' interval. One uterine leiomyoma was diagnosed 15 years earlier, and it has been stable in size without causing any problem. No pregnancy or abortion has been reported.