raltegravir-potassium and Lymphoma--AIDS-Related

Topics: Adenine; Amoxicillin; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Clarithromycin; Female; Helicobacter Infections; Helicobacter pylori; HIV-1; Humans; Lansoprazole; Lymphoma, AIDS-Related; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Organophosphonates; Pyrrolidinones; Raltegravir Potassium; Tenofovir

A 38-year-old HIV positive man suffered from right upper abdominal pain and oesophageal reflux syndromes. He was in a good general state of health and nutrition with no concomitant symptoms.. A small bowel tumor and slight soor esophagitis had been diagnosed by esophago-gastroduodenoscopy. The tumor was histologically classified as Burkitt?s lymphoma.. The patient received 6 cycles of chemotherapy according to the B-ALL protocol, and antiretroviral therapy with lamivudine (300 mg), abacavir (600 mg) und raltegravir (2 × 400 mg) was initiated immediately. After the first cycle of chemotherapy a complete remission of Burkitt?s lymphoma was achieved. Laboratory parameters recovered after completion of 6 cycles to a value of 400 CD4-positive lymphocytes/mm (3) with a viral load of HIV-1-RNA 20 - 300 copies/ml in plasma.. Immediate initiation of antiretroviral therapy is essential after the diagnosis of AIDS-defining symptoms. The choice of an appropriate treatment regimen is a critical factor in order to avoid toxic drug interactions and adverse events while maintaining a highly effective treatment.

Topics: Adult; Anti-HIV Agents; Antineoplastic Combined Chemotherapy Protocols; Burkitt Lymphoma; CD4 Lymphocyte Count; Dideoxynucleosides; Dose-Response Relationship, Drug; Drug Administration Schedule; Duodenal Neoplasms; HIV Seropositivity; Humans; Intestine, Small; Lamivudine; Lymphoma, AIDS-Related; Male; Pyrrolidinones; Raltegravir Potassium; Remission Induction; Viral Load

To describe the antiretroviral management of a patient diagnosed simultaneously with HIV/AIDS and diffuse large B-cell lymphoma, focusing on the drug-drug interactions between highly active antiretroviral therapy (HAART) and concomitant cancer chemotherapy.. A 55-year-old white man was recently diagnosed with HIV/AIDS and presented 1 month later with complaints of nausea, vomiting, abdominal pain, double vision, right eye discomfort/swelling, and a 3.6-kg weight loss. An excisional biopsy of a right inguinal lymph node confirmed a new diagnosis of diffuse large B-cell lymphoma. HAART and a chemotherapeutic regimen, including cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) with intrathecal methotrexate, was to be initiated. As the potential for multiple drug-drug interactions existed, raltegravir, abacavir, and lamivudine were chosen for the initial HAART regimen. The patient achieved and maintained an undetectable viral load throughout 6 CHOP cycles.. HAART improves the chemotherapeutic response in patients with HIV and lymphoma. Multiple drug-drug interactions are possible in patients who are to receive CHOP and HAART. Cyclophosphamide and vincristine are metabolized via the CYP3A4 isoenzyme. Protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors both inhibit and induce CYP3A4, with the potential for altered chemotherapeutic and cytotoxic effects. When PIs are combined with CHOP, mortality is reduced, but increased adverse effects are demonstrated. Raltegravir, an integrase inhibitor, is eliminated via glucuronidation and results in minimal drug-drug interactions. Raltegravir improves virologic and immunologic responses in HAART-naïve patients and thus would be a suitable alternative for preventing chemotherapeutic-HAART interactions.. There is limited information published regarding the potential for interactions between HAART and cancer chemotherapy. While further research is necessary, it is important for clinicians to consider the potential for drug-drug interactions when designing a HAART regimen concurrently with chemotherapy.

Topics: Acquired Immunodeficiency Syndrome; Antineoplastic Combined Chemotherapy Protocols; Antiretroviral Therapy, Highly Active; Cyclophosphamide; Doxorubicin; Drug Interactions; HIV Integrase Inhibitors; Humans; Lymphoma, AIDS-Related; Lymphoma, Large B-Cell, Diffuse; Male; Methotrexate; Middle Aged; Prednisone; Pyrrolidinones; Raltegravir Potassium; Vincristine