efavirenz--emtricitabine--tenofovir-disoproxil-fumarate-drug-combination and Acquired-Immunodeficiency-Syndrome

A 35-year-old male patient with a large unilateral haemorrhagic conjunctival tumour lesion and another contralateral haemorrhagic conjunctival flat lesion associated with violaceous cutaneous macules on the extremities and angiomatous lesions in the upper gastrointestinal tract as initial clinical manifestation of HIV-related immunodeficiency. Cutaneous, gastric mucosal and conjunctival biopsy was consistent with Kaposi's sarcoma with complete remission after highly active antiretroviral therapy and systemic chemotherapy.. HIV-related conjunctival Kaposi's sarcoma, even a large one, can have a good response to antiretroviral therapy and systemic chemotherapy without any additional topical eye treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Antibiotics, Antineoplastic; Antiretroviral Therapy, Highly Active; Conjunctival Neoplasms; Doxorubicin; Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Humans; Immunocompromised Host; Male; Remission Induction; Sarcoma, Kaposi; Skin Neoplasms; Stomach Neoplasms

Central nervous system (CNS) adverse events are common with initiation of efavirenz, but these are often described as transient. We aimed to describe the outcomes of individuals commencing Atripla (Gilead Sciences Inc, Foster City, California; Bristol-Myers Squibb Co, Princeton, New Jersey, USA) as a first-line regimen.. We performed a retrospective case-based analysis of all individuals within our HIV cohort who had received Atripla as their first antiretroviral combination. In individuals who discontinued Atripla data was collected on evolution of adverse events.. Four hundred and seventy-two individuals commenced Atripla as first-line therapy at 12 months, 383 individuals (81%) remained on Atripla with 98% achieving HIV-1 RNA less than 50 copies/ml (on treatment analysis). CNS toxicity was the commonest reason for switching therapy in 63 (71%) cases. The median duration of first reported CNS toxicity was 27 days (IQR 7-104 days) and the commonest reported symptoms were nightmares or vivid dreams in 28 (44%), insomnia in 27 (43%) and depression in 22 (35%). In those with CNS toxicity, six (10%) switched at 0-4 weeks, four (6%) at 4-12 weeks, 30 (48%) at 12-52 weeks and 23 (36%) changed regimen 52-96 weeks after commencing Atripla. Among those with available documentation 25 of 63 (40%) had reported improvement or resolution of their CNS side effects.. One-fifth of all individuals commencing Atripla will need to switch therapy, often for adverse events. The commonest reason for switch in our cohort was CNS toxicity, which although it may develop shortly after initiation may persist, ultimately leading to discontinuation of Atripla months or years later.

Topics: Acquired Immunodeficiency Syndrome; Adenine; Adult; Anti-HIV Agents; California; Central Nervous System Diseases; Cohort Studies; Deoxycytidine; Depression; Dreams; Drug Combinations; Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Female; Humans; Male; New Jersey; Organophosphonates; Oxazines; Retrospective Studies; Reverse Transcriptase Inhibitors; Risk Factors; Sleep Initiation and Maintenance Disorders

Topics: Acquired Immunodeficiency Syndrome; Adenine; Antiretroviral Therapy, Highly Active; Deoxycytidine; Drug Administration Schedule; Drug Combinations; Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; HIV Infections; Humans; Organophosphonates; Oxazines; Viral Load