ABSTRACT
A multitude of rheumatologic manifestations have been associated with HIV infection and protease inhibitors use. We describe two cases that display a temporal relationship between initiating Kaletra and developing Achilles tendinopathy. Immediate and dramatic resolution of symptoms occurred on switching from Kaletra to an alternative agent. Clinicians may want to consider a trial of an alternative agent in individuals on Kaletra who experience Achilles tendinopathy. Adverse events must be formally reported so that our understanding of antiretrovirals may continually evolve and aid decisions about antiretroviral prescribing.
Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Lopinavir/adverse effects , Ritonavir/adverse effects , Tendinopathy/chemically induced , Achilles Tendon/pathology , Adult , CD4 Lymphocyte Count , Drug Combinations , HIV Protease Inhibitors/therapeutic use , Humans , Lopinavir/urine , Magnetic Resonance Imaging , Male , Ritonavir/urine , Treatment OutcomeABSTRACT
Salting-out assisted liquid-liquid extraction (SALLE) applies the salting-out effect to separate water-miscible organic solvent such as acetonitrile from plasma or other aqueous biofluids, and can extract a wide range of drug and metabolites, including many hydrophilic compounds. In most cases, the separated organic phase can be directly injected for bioanalysis, or with a simple dilution. SALLE provides similar simplicity to protein precipitation, but cleaner extracts due to a true phase separation. SALLE is also faster, more environmentally friendly and more cost-efficient than conventional liquid-liquid extraction and SPE. Through 96-well automation, SALLE can be easily integrated into the overall high-throughput LC-MS/MS bioanalysis strategy to increase productivity. This article provides a critical overview of the literatures on SALLE and perspectives of the future bioanalytical application of this often overlooked extraction technique. Important parameters impacting SALLE-LC-MS/MS assays are also discussed.
