<p>The following have been observed in patients receiving Lopinavir and Ritonavir:<br />
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<strong>Hepatotoxicity</strong>: Patients with underlying hepatitis B or C or marked elevations in transaminase prior to treatment may be at increased risk for developing or worsening of transaminase elevations or hepatic decompensation with use of this combination.<br />
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<strong>QT Interval Prolongation</strong>: In cases of QT interval prolongation and torsade de pointes have been reported although causality of this combination could not be established. Avoid use in patients with congenital long QT syndrome, those with hypokalemia, and with other drugs that prolong the QT interval.<br />
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<strong>PR Interval Prolongation</strong>: Lopinavir/ritonavir prolongs the PR interval in some patients. Cases of second or third degree atrioventricular block have been reported. This combination should be used with caution in patients with underlying structural heart disease, pre-existing conduction system abnormalities, ischemic heart disease or cardiomyopathies, as these patients may be at increased risk for developing cardiac conduction abnormalities.<br />
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<strong>Diabetes Mellitus/Hyperglycemia</strong>: New onset diabetes mellitus, exacerbation of pre-existing diabetes mellitus, and hyperglycemia have been reported in HIV-1 infected patients receiving protease inhibitor therapy. Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, diabetic ketoacidosis has occurred. In those patients who discontinued protease inhibitor therapy, hyperglycemia persisted in some cases.<br />
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<strong>Lipid Elevations</strong>: Treatment with Lopinavir and Ritonavir has resulted in large increases in the concentration of total cholesterol and triglycerides.</p>