ABSTRACT
HIV is now a manageable chronic condition with a near-normal life expectancy if diagnosed early. Treatment can be a simple 'one tablet, once a day' regimen with minimal side effects or interactions with other medication. Unfortunately, healthcare professionals' perception of risk of HIV infection is often incorrect and patients remain undiagnosed because healthcare professionals assume that their patients are not at risk of HIV. This report demonstrates a case of missed HIV diagnosis in the military primary care setting and its consequences because of incorrect assumption rather than presenting clinical conditions.
Subject(s)
Diagnostic Errors , HIV Infections/diagnosis , Military Personnel , Primary Health Care , Adult , Humans , Male , Risk Assessment , United KingdomABSTRACT
NATO describes 'Role 4' military medical services as those provided for the definitive care of patients who cannot be treated within a theatre of operations and these are usually located in a military force's country of origin and may include the involvement of civilian medical services. The UK Defence Medical Services have a proud history of developing and providing clinical services in infectious diseases and tropical medicine, sexual health and HIV medicine, and medical microbiology and virology. These UK Role 4 Military Infection Services have adapted well to recent overseas deployments, but new challenges will arise due to current military cutbacks and a greater diversity of contingency operations in the future. Further evidence-based development of these services will require leadership by military clinicians and improved communication and support for 'reach-back' services.
Subject(s)
Communicable Disease Control/trends , Military Medicine/trends , Tropical Medicine/trends , Communicable Disease Control/history , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Military Medicine/history , Military Medicine/organization & administration , Sexually Transmitted Diseases/history , Sexually Transmitted Diseases/prevention & control , Tropical Medicine/history , United KingdomABSTRACT
Sexual acquisition of infections has always been an important part of military history and although disease patterns have changed over time, the problem has not gone away. This article will look at how to recognise infection, the general principles of management, where to access guidance and how to get specialised help within the complexities of the military environment.
Subject(s)
Military Personnel , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Ulcer/microbiology , Vaginal Discharge/microbiology , Asymptomatic Infections , Condylomata Acuminata/drug therapy , Condylomata Acuminata/prevention & control , Condylomata Acuminata/virology , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/transmission , Herpes Genitalis/complications , Humans , Male , Sexually Transmitted Diseases/complications , Sexually Transmitted Diseases/therapy , Syphilis/complicationsSubject(s)
Anti-HIV Agents/pharmacokinetics , Cyclohexanes/pharmacokinetics , Drug Interactions , HIV Infections/drug therapy , Hepatitis B/drug therapy , Immunosuppressive Agents/pharmacokinetics , Tacrolimus/pharmacokinetics , Triazoles/pharmacokinetics , Anti-HIV Agents/administration & dosage , Carcinoma, Hepatocellular/surgery , Cyclohexanes/administration & dosage , HIV Infections/complications , Hepatitis B/complications , Humans , Immunosuppressive Agents/administration & dosage , Liver Transplantation , Male , Maraviroc , Middle Aged , Plasma/chemistry , Tacrolimus/administration & dosage , Treatment Outcome , Triazoles/administration & dosageABSTRACT
OBJECTIVES: To describe the pharmacokinetics of maraviroc when dosed at 150 or 300 mg once daily with 800/100 mg of darunavir/ritonavir. METHODS: A retrospective case-note review of HIV-infected adults taking maraviroc was conducted. Patients on a maraviroc-based regimen for a minimum of 5 weeks were grouped as receiving: (i) 300 mg of maraviroc twice daily with 245 mg of tenofovir/200 mg of emtricitabine; (ii) 300 mg of maraviroc once daily with 800/100 mg of darunavir/ritonavir once daily; and (iii) 150 mg of maraviroc once daily with 800/100 mg of darunavir/ritonavir once daily. C(trough) and C(peak) data were collected at 2, 12 or 24 h post-dose. RESULTS: Sixty-six patients were included, providing 115 samples. The median (IQR) C(peak) was 378 (350-640) ng/mL for 300 mg of maraviroc twice daily with 245 mg of tenofovir/200 mg of emtricitabine (n=9), 728 (378-935) ng/mL for 300 mg of maraviroc once daily with darunavir/ritonavir (n=29) and 364 (104-624) ng/mL for 150 mg of maraviroc once daily with darunavir/ritonavir (n=2; P=0.24). The median (IQR) C(trough) was 46 (33-61) ng/mL for 300 mg of maraviroc twice daily with 245 mg of tenofovir/200 mg of emtricitabine (n=12), 70 (49-97) ng/mL for 300 mg of maraviroc once daily with darunavir/ritonavir (n=34) and 43 (35-55) ng/mL for 150 mg of maraviroc once daily with darunavir/ritonavir (n=17; P=0.001). The maraviroc C(trough) in black patients (n=34) was 61 (45-110) ng/mL and in white patients (n=29) it was 49 (42-70) ng/mL (P=0.04). The C(peak) in black patients (n=20) was 800 (397-1060) ng/mL versus 387 (336-723) ng/mL in white patients (n=20; P=0.02). CONCLUSIONS: Once daily coadministration of 300 mg of maraviroc with 800/100 mg of darunavir/ritonavir was well tolerated and had favourable pharmacokinetics when compared with 300 mg of maraviroc twice daily with 245 mg of tenofovir/200 mg of emtricitabine. A 24% higher C(trough) and 107% higher C(peak) was seen in black patients compared with white patients.
Subject(s)
Anti-HIV Agents/administration & dosage , Anti-HIV Agents/pharmacokinetics , Cyclohexanes/administration & dosage , Cyclohexanes/pharmacokinetics , HIV Infections/drug therapy , Ritonavir/administration & dosage , Sulfonamides/administration & dosage , Triazoles/administration & dosage , Triazoles/pharmacokinetics , Adult , Darunavir , Drug Interactions , Female , Humans , Male , Maraviroc , Middle Aged , Retrospective StudiesABSTRACT
Variable antiretroviral drug penetration into the genital tract may contribute to the differential evolution of HIV-1 and the emergence of drug resistance. We compared concentrations of darunavir in 34 time-matched blood plasma and seminal plasma samples from 18 HIV-1 positive men. Darunavir in seminal plasma were approximately 10-20% of that achieved in blood at matched time points postdrug ingestion. All seminal plasma darunavir were above the protein-corrected EC50 values for wild-type HIV-1.
