raltegravir-potassium and Rhabdomyolysis

Raltegravir is the first integrase inhibitor antiretroviral agent that has been demonstrated to have antiviral efficacy and safety. However, the US Food and Drug Administration has recommended use with caution in patients with risk factors for rhabdomyolysis, based on four case reports of rhabdomyolysis in patients with identifiable risk factors. We present a 32-year-old Asian man with human immunodeficiency virus (HIV), but without other underlying diseases, who developed rapid-onset, raltegravir-associated rhabdomyolysis and hyperlactatemia. Our patient lacked predisposing factors for rhabdomyolysis, and the rapid onset time of 4 days was the shortest reported. Therefore, clinicians should exercise caution when using raltegravir and closely monitor all patients for the symptoms of muscle pain and weakness. This case has been reported to the National Adverse Drug Reactions Reporting System of the Department of Health in Taiwan.

Topics: Adult; Anti-Retroviral Agents; Asian People; HIV Infections; Humans; Hyperlactatemia; Male; Raltegravir Potassium; Rhabdomyolysis; Taiwan; Time

To evaluate the frequency of myopathy and serum creatine kinase (CK) elevation associated with the use of the integrase inhibitor raltegravir we conducted a retrospective, cohort analysis assessing the incidence of skeletal muscle toxicity among HIV-infected patients treated with raltegravir. Adult HIV-infected patients who started a raltegravir-containing therapy were enrolled into the study. The skeletal muscle toxicity was defined by the presence of one or more of the following parameters: (1) isolated and significant CK elevation without signs or symptoms; (2) diffuse myalgia without weakness; (3) proximal muscle weakness; (4) rhabdomyolysis. On the whole, 155 patients were included in the study, with a mean age of 49.2 years; the median duration of the raltegravir treatment was 30.7 months. The overall frequency of skeletal muscle toxicity was 23.9%, with an incidence of 4.7/100 person-years. An isolated CK elevation was reported in 21.3% of cases, while less than 3% of patients complained of myalgia or muscle weakness. The CK elevation was usually of grade 1 or 2 and self-limiting, and laboratory or clinical abnormalities did not require discontinuation of raltegravir in any patient. Factors significantly associated with skeletal muscle toxicity were previous use of zidovudine, higher baseline CK levels, previous increase of the CK levels, and a higher body mass index. Skeletal muscle toxicity is not an unusual adverse event in subjects receiving raltegravir, but it is usually represented by a mild-to-moderate increase in CK concentration, while clinical symptoms of myopathy are very uncommon.

Topics: Anti-HIV Agents; Creatine Kinase; Female; HIV Infections; Humans; Male; Middle Aged; Muscle Weakness; Muscle, Skeletal; Myalgia; Pyrrolidinones; Raltegravir Potassium; Retrospective Studies; Rhabdomyolysis

Topics: Aged; HIV Infections; HIV Integrase Inhibitors; HIV-1; Humans; Male; Pyrrolidinones; Raltegravir Potassium; Rhabdomyolysis

Topics: Acute Kidney Injury; Adult; Antiviral Agents; Hepatitis C, Chronic; HIV Infections; Humans; Male; Pyrrolidinones; Raltegravir Potassium; Rhabdomyolysis

Raltegravir (RAL), an HIV integrase inhibitor, may uncommonly induce an increase of serum creatine kinase (CK) both in naïve and antiretroviral (ARV)-experienced HIV-positive patients. We report the case of severe rhabdomyolysis requiring hospitalization in an ARV-experienced HIV/hepatitis C co-infected patient treated with a RAL-containing drug regimen. Factors favouring a severe clinical occurrence of RAL-induced rhabdomyolysis from cases reported in literature are described.

Topics: Alanine Transaminase; Aspartate Aminotransferases; Creatine Kinase; Female; HIV Infections; HIV Integrase Inhibitors; Humans; L-Lactate Dehydrogenase; Middle Aged; Pyrrolidinones; Raltegravir Potassium; Rhabdomyolysis

Topics: Antiretroviral Therapy, Highly Active; HIV Infections; HIV Integrase Inhibitors; Humans; Male; Middle Aged; Pyrrolidinones; Raltegravir Potassium; Rhabdomyolysis