RESUMEN
In this case report, we examine the impact of a simplified two-drug highly active antiretroviral therapy (HAART) regimen of raltegravir and lamivudine in a patient co-infected with human immunodeficiency virus (HIV) and hepatitis C, D and B viruses (HCV/HDV/HBV) under immunosuppressive therapy after liver transplantation. Pharmacokinetic interactions between integrase inhibitors and immunosuppressant drugs are described. Raltegravir, the first integrase inhibitor, associated with lamivudine, was introduced because its metabolism does not interfere with immunosuppressant therapy. During post-orthotopic liver transplantation follow-up, the patient's transaminases level increased and his antiretroviral therapy (HAART) of tenofovir/emtricitabine and fosamprenavir was changed, due to suspected drug toxicity. After seven months of follow-up, the patient showed good tolerance, good viro-immunological control with undetectable HIV viraemia and stable concentrations of immunosuppressive drugs. This case indicates that the combination of raltegravir and lamivudine is an optimal and effective strategy because it resulted in an important reduction of hepatic transaminases in a patient with very critical clinical conditions.
RESUMEN
Sustained increase of serum creatine phosphokinase (CPK) concentrations and muscle abnormalities have been reported in patients taking raltegravir (RAL). In this report, we describe a case of sustained and asymptomatic increase of serum CPK concentrations associated with raltegravir, zidovudine, and lamivudine in an HIV-1 experienced patient with intolerance to protease inhibitor, abacavir and penicillin during 32 weeks of continuous drug monitoring.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Lamivudine/uso terapéutico , Debilidad Muscular/inducido químicamente , Mialgia/inducido químicamente , Pirrolidinonas/efectos adversos , Zidovudina/uso terapéutico , Terapia Antirretroviral Altamente Activa , Creatina Quinasa/sangre , Humanos , Masculino , Persona de Mediana Edad , Raltegravir PotásicoRESUMEN
Sustained increase of serum creatine phosphokinase (CPK) concentrations and muscle abnormalities have been reported in patients taking raltegravir (RAL). In this report, we describe a case of sustained and asymptomatic increase of serum CPK concentrations associated with raltegravir, zidovudine, and lamivudine in an HIV-1 experienced patient with intolerance to protease inhibitor, abacavir and pencillin during 32 weeks of continuous drug monitoring.
Un aumento sostenido de las concentraciones de creatina fosfoquinasa sérica (CPK) y las anormalidades musculares ha sido reportado en relación con pacientes que toman raltegravir (RAL). En este reporte, describimos un caso de aumento sostenido y asintomático de concentraciones séricas de CPK asociadas con raltegravir, zidovudina y lamivudina en un paciente experimentado de VIH-1 con intolerancia al inhibidor de la proteasa, al abacavir y la penicilina durante 32 semanas de monitoreo farmacológico continuo.