TITLE

Raltegravir dosage adjustment in HIV-infected patients receiving etravirine

AUTHOR(S)
DO, VI T.; HIGGINSON, ROBERT T.; FULCO, PATRICIA PECORA
PUB. DATE
November 2011
SOURCE
American Journal of Health-System Pharmacy;11/1/2011, Vol. 68 Issue 21, p2049
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Purpose. The pharmacokinetic interaction of etravirine and raltegravir is reviewed, with discussion of implications for clinical practice. Summary. Etravirine (a second-generation nonnucleoside reverse transcriptase inhibitor) and raltegravir (an integrase strand-transfer inhibitor) are two agents approved by the Federal Food and Drug Administration for use in human immunodeficiency virus (HIV) treatment-resistant patients. Minimal data exist on the concurrent use of raltegravir with etravirine. This combination would offer treatment-experienced HIV patients a novel pharmacotherapy plan including two new fully active agents. Etravirine induces uridine diphosphate-glucuronosyltransferase 1A1 and reduces the raltegravir minimum concentration (Cmin) by 34% when administered concurrently in healthy volunteers. In a case series of four HIV treatment-resistant patients initiated on an antiretroviral regimen including standard doses of etravirine and raltegravir, poor virological control was demonstrated. Two of these four patients had a raltegravir Cmin below the 95% minimum inhibitory concentration. In a larger study (n = 103), sustained virological control (viral loads of <50 copies/mL) resulted when HIV treatment-resistant patients received standard doses of darunavir, ritonavir, etravirine, raltegravir, and nucleoside analogs with or without enfuvirtide. Debate exists regarding the best raltegravir pharmacokinetic parameter to evaluate (Cmin or the area under the concentration curve/50% effective concentration). Recent data in HIV treatment-naive patients support a negative association between a low raltegravir Cmin (≤43 ng/mL) and virological suppression. Conclusion. The need to adjust the dosage of raltegravir in HIV-infected patients who are also receiving etravirine is unclear. In such patients who have an extensive history of HIV disease treatment, prescribing raltegravir 1200 mg/day, rather than the standard 800 mg/day, may be prudent to prevent the development of treatment-resistant virus and to achieve an optimal virological response.
ACCESSION #
66907988

 

Related Articles

  • Abstracts ICAR 2010.  // Infection;Jun2010, Vol. 38, p1 

    The article presents abstracts on AIDS and retroviruses research including the efficacy of Maraviroc (MVC) in treating HIV-1 patients, HIV infection of man having sex with man and efficacy and safety of maraviroc, raltegravir, etravirine in treating R5 HIV-infected patients.

  • Is Chewed Raltegravir an Option to Care for HIV-Infected Patients With Active Tuberculosis? Gervasoni, Cristina; Riva, Agostino; Impagnatiello, Caterina; Galli, Massimo; Cattaneo, Dario // Clinical Infectious Diseases;Aug2013, Vol. 57 Issue 3, p480 

    The article focuses on the care for HIV-Infected patients with tuberculosis. It highlights the challenges of utilization of rifampicin and antiretroviral drugs (ARV). It discusses the metabolization of HIV integrase inhibitor raltegravir (RAL) by Uridine 5'-diphospho-glucuronosyl transferase...

  • OF SPECIAL INTEREST.  // American Journal of Health-System Pharmacy;11/1/2011, Vol. 68 Issue 21, p2003 

    The article offers brief information on the topics discussed in the articles within the issue. An anticoagulation teaching service which involves pharmacy students and residents reduced the 60-day readmission rate for patients discharged on warfarin. A raltegravir dosage of 1200 mg/day is...

  • Response letter to H Honda et al. – Raltegravir use in warfarin treated HIV patients (Int J STD AIDS 2012;23:903–904). Pammi, Manjula // International Journal of STD & AIDS;Nov2013, Vol. 24 Issue 11, p916 

    A letter to the editor is presented in response to the article "Safe use of raltegravir in HIV-1 infected patients treated with warfarin," by H. Honda and colleagues in the 2012 issue.

  • Latest advice from the SMC.  // PharmacoEconomics & Outcomes News;9/21/2013, Issue 687, p11 

    The article discusses a document published by the Scottish Medicines Consortium (SMC) on September 9, 2013 which recommended raltegravir, etravirine and tenofovir disoproxil as treatments for paediatric patients with HIV-1 infections.

  • Efavirenz vs etravirine: which makes more SENSE?  // Reactions Weekly;2/5/2011, Issue 1337, p2 

    The article discusses a study which compared neuropsychiatric adverse events during 12 weeks of treatment with etravirine in HIV-1-infected population.

  • Integrase inhibitor-based treatment in clinical practice. Cenderello, G.; Piscopo, R.; Feasi, M.; Penco, G.; Bobbio, N.; Cassola, G. // Journal of the International AIDS Society;2010 Supplement 4, Vol. 13 Issue Suppl 4, p1 

    An abstract of the article "Integrase inhibitor-based treatment in clinical practice," by G. Cenderello and colleagues is presented.

  • Switching to a 'nuke-sparing' raltegravir/ atazanavir combination: an individualised approach. Grant, A.; Kamuntu, Y.; Read, P.; Kulasegaram, R. // Journal of the International AIDS Society;2010 Supplement 4, Vol. 13 Issue Suppl 4, p1 

    An abstract of the article "Switching to a 'nuke-sparing' raltegravir/ atazanavir combination: an individualised approach," by A. Grant and colleagues is presented.

  • Portuguese cohort: raltegravir with optimized background therapy (OBT) in multiple-experienced HIV1- and HIV2-infected patients. Doroana, M.; Piñeiro, C.; Maltez, F.; Fonseca, P.; Oliveira, J.; Mansinho, K.; Horta, A.; Teófilo, E.; Aguas, M.; Germano, I.; Faria, D. // Journal of the International AIDS Society;2010 Supplement 4, Vol. 13 Issue Suppl 4, p1 

    An abstract of the article "Portuguese cohort: raltegravir with optimized background therapy (OBT) in multiple-experienced HIV1- and HIV2-infected patients," by M. Doroana and colleagues is presented.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics