Increased bleeding associated with protease inhibitor therapy in HIV-positive patients with bleeding disorders

he use of protease inhibitor (PI) drugs in treatment regimens for HIV-infec ted patients with hereditary bleeding disorders has been associated with an increased bleeding tendency To characterize the nature of this bleeding te ndency, a retrospective case record analysis was performed on 67 HIV-positi ve patients with hereditary breeding disorders who had been treated with PI therapy. 34 patients (51%) developed an increased bleeding tendency on PI therapy usually within the first few weeks of treatment. As well as an incr ease in usual joint bleeds, patients developed spontaneous atypical small j oint, soft tissue and muscle bleeds. Haematuria was also common. Bleeding e pisodes tended to respond suboptimally to factor concentrate replacement. R itonavir was most likely to be associated with bleeding. Nine patients swit ched first-line PI therapy as a direct consequence of bleeding and seven ha d no further bleeding problem on their second PI. Factor concentrate usage was significantly increased during the first 6 months of PI therapy compare d to the 6 months preceeding treatment. PI therapy is frequently associated with increased bleeding in patients with hereditary bleeding disorders. Th e mechanism of the bleeding tendency remains to be elucidated.