raltegravir-potassium and Kidney-Failure--Chronic

Topics: Anti-Retroviral Agents; DNA, Viral; HIV Infections; HIV-1; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Raltegravir Potassium; Treatment Outcome

Non-nucleoside reverse transcriptase inhibitors and enfuvirtide are ineffective against HIV-2 replication. These considerations may have particular significance in the formulation of second-line or salvage regimens for HIV-2 infection when resistance or toxicity precludes the use of protease inhibitors (PIs) or specific nucleoside analogues. We describe a case of a treatment-experienced patient with important limitations in therapeutic options dictated by the presence of HIV-2 infection, severe HIV nephropathy (requiring haemodialysis), intolerance to PIs and clinical contraindications to the use of some nucleoside analogues (anaemia, pancreatic toxicity and high cardiovascular risk). A three-drug regimen based on raltegravir, tenofovir disoproxil fumarate and lamivudine was given, with no major toxicity, good immunological response and complete viral suppression. Our case indicates that regimens based on integrase inhibitors could represent an effective alternative in PI-resistant or PI-intolerant patients with HIV-2, and that tenofovir disoproxil fumarate may be used in patients with end-stage renal disease requiring haemodialysis who cannot take other nucleoside analogues because of treatment-limiting adverse effects.

Topics: Adenine; Adult; Anti-HIV Agents; Drug Therapy, Combination; HIV Infections; HIV-2; Humans; Kidney Failure, Chronic; Lamivudine; Male; Organophosphonates; Protease Inhibitors; Pyrrolidinones; Raltegravir Potassium; Renal Dialysis; Salvage Therapy; Tenofovir; Treatment Outcome

Little is known about raltegravir removal by hemodialysis in patients with end-stage renal disease (ESRD). We therefore measured raltegravir concentrations in plasma in pre- and postdialyzer blood samples from 2 ESRD HIV-infected patients. The hemodialysis extraction ratio and raltegravir hemodialysis clearance were 5.5% and 9.1 ml/min in patient 1 and 9.5% and 19.1 ml/min in patient 2, respectively. Our results suggest minimal raltegravir removal by hemodialysis with no specific raltegravir dosage adjustments required in HIV-infected patients undergoing hemodialysis.

Topics: HIV Infections; HIV Integrase Inhibitors; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pyrrolidinones; Raltegravir Potassium; Renal Dialysis