ABSTRACT
The development of newer agents such as raltegravir, etravirine and maraviroc has improved the perspective of viral load suppression. However, there is not enough data regarding their use together. In this study, we describe nine patients who were triple-class experienced and were on a salvage regimen consisting of a combination of raltegravir, etravirine, and maraviroc. Our results showed that this regimen is safe with no major side effect and has good virological efficacy with two-thirds of the patients achieving an undetectable viral load by 24 weeks.
Subject(s)
Anti-HIV Agents , Raltegravir Potassium , Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Humans , Viral LoadSubject(s)
Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , Clinical Laboratory Techniques/economics , Clinical Laboratory Techniques/methods , Drug Monitoring/economics , Drug Monitoring/methods , HIV Infections/drug therapy , Adult , CD4 Lymphocyte Count , Cohort Studies , Female , Humans , Male , Middle Aged , RNA, Viral/blood , Retrospective Studies , Treatment Outcome , Viral LoadABSTRACT
Pyogenic liver abscesses are rarely encountered in HIV-infected patients living outside of temperate climates and are usually polymicrobial in nature, with a majority of the pathogens arising from gastrointestinal flora. We describe the second case of a liver abscess in an HIV-positive individual that was caused by methicillin-resistant Staphylococcus aureus (MRSA), most likely due to a partially treated community-acquired MRSA skin abscess. The liver abscess was successfully managed by percutaneous drainage and intravenous antibiotics. This case underlines the ubiquitous nature of community-acquired MRSA and its possible unusual presentations in immunocompromised hosts.
Subject(s)
HIV Infections/diagnosis , HIV Infections/microbiology , Liver Abscess/diagnosis , Liver Abscess/microbiology , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/diagnosis , Adult , Female , Humans , Liver Abscess/virology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/virologyABSTRACT
Maraviroc is a small molecule and a member of a new class of antiretroviral compounds known as CCR5 antagonists, which block R5-tropic HIV entry into CD4 cells. HIV entry into the cell requires binding to a CD4 molecule and, in the majority of cases, to a coreceptor, either chemokine coreceptor 4 (CXCR4) or 5 (CCR5). In August 2007, the US FDA approved maraviroc for use in combination with other antiretroviral agents for treatment-experienced adults infected with CCR5-tropic HIV-1 only and who have evidence of viral replication. Maraviroc prevents the virus from entering uninfected cells by blocking the CCR5 coreceptor. Maraviroc has two dose formulations (150- and 300-mg tablets) and can be taken with or without food. The dosing recommendations are based on concomitant medications due to drug interactions. It is excreted primarily in the feces, with approximately 25% via urine. The safety and efficacy of maraviroc have not been established in pregnant women or pediatric patients. Maraviroc has been shown to achieve an undetectable HIV-1 RNA level in clinically advanced, class 3 antiretroviral treatment-experienced adults with evidence of CCR5-tropic HIV-1 replication despite ongoing antiretroviral therapy. It is generally well tolerated and its development is responding to a desperate need for new classes of antiretroviral agents that can target novel steps of the HIV lifecycle and do not share crossresistance with currently available therapy.
Subject(s)
Anti-HIV Agents , CCR5 Receptor Antagonists , Cyclohexanes , HIV Fusion Inhibitors , HIV Infections/drug therapy , HIV-1/drug effects , Triazoles , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/adverse effects , Anti-HIV Agents/chemistry , Anti-HIV Agents/therapeutic use , Child , Clinical Trials as Topic , Cyclohexanes/administration & dosage , Cyclohexanes/adverse effects , Cyclohexanes/chemistry , Cyclohexanes/therapeutic use , Female , HIV Fusion Inhibitors/administration & dosage , HIV Fusion Inhibitors/adverse effects , HIV Fusion Inhibitors/chemistry , HIV Fusion Inhibitors/therapeutic use , HIV Infections/virology , Humans , Male , Maraviroc , Pregnancy , Treatment Outcome , Triazoles/administration & dosage , Triazoles/adverse effects , Triazoles/chemistry , Triazoles/therapeutic useSubject(s)
HIV Envelope Protein gp41/administration & dosage , HIV Infections/drug therapy , HIV-1/drug effects , Peptide Fragments/administration & dosage , Pyrrolidinones/administration & dosage , Quality of Life , Viral Load , Adult , Drug Administration Schedule , Enfuvirtide , Female , HIV Envelope Protein gp41/therapeutic use , HIV Fusion Inhibitors/administration & dosage , HIV Fusion Inhibitors/therapeutic use , HIV Infections/virology , HIV Integrase Inhibitors/administration & dosage , HIV Integrase Inhibitors/therapeutic use , HIV-1/physiology , Humans , Male , Middle Aged , Peptide Fragments/therapeutic use , Pyrrolidinones/therapeutic use , Raltegravir Potassium , Surveys and Questionnaires , Time Factors , Treatment OutcomeSubject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/therapeutic use , Ritonavir/therapeutic use , Sulfonamides/therapeutic use , Viremia/drug therapy , Adult , Darunavir , Drug Therapy, Combination , Female , Genotype , Humans , Male , Middle Aged , Mutation/drug effects , RNA , Viral LoadABSTRACT
Meningitis due to methicillin-resistant Staphylococcus aureus is a rare clinical presentation but has been well documented in postneurosurgical patients. To our knowledge, no case of methicillin-resistant Staphylococcus aureus meningitis has been previously reported in a nonneurosurgical patient with AIDS. In this case report we describe a person with AIDS who had no history of a neurosurgical procedure, shunt devices, head trauma, or recent hospitalization that presented with methicillin-resistant Staphylococcus aureus meningitis. The infection was successfully treated. Methicillin-resistant Staphylococcus aureusshould be considered in the differential of meningitis in people with AIDS.
Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Acquired Immunodeficiency Syndrome/complications , Meningitis, Bacterial/microbiology , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/microbiology , Adult , Humans , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purificationABSTRACT
Raltegravir (formerly known as MK-0518; Isentress) is the first in a new class of integrase inhibitors approved for the use in treatment-experienced adult patients who have evidence of viral replication and HIV strains resistant to multiple antiretroviral agents. It is dosed twice daily with or without food. Raltegravir is a novel antiretroviral that has been shown to be well tolerated. It has demonstrated potent efficacy in the virologic suppression of HIV-1 RNA levels up to 48 weeks in two controlled studies that were conducted in clinically advanced, three-class antiretroviral, treatment-experienced adults.
