Raltegravir, tenofovir, and emtricitabine in an HIV-infected patient with HCV chronic hepatitis, NNRTI intolerance and protease inhibitors-induced severe liver toxicity.
BACKGROUND
In HIV-infected patients with HCV-related chronic hepatitis, liver impairment and drug toxicity may substantially reduce the number of possible therapeutic options.


METHODS
we here describe the case of an HCV-HIV coinfected woman who had repeated severe episodes of drug-related liver toxicity with indinavir, saquinavir, fosamprenavir, and darunavir, with minimal further therapeutic options left in this class. Previous treatment-limiting side effects with efavirenz and nevirapine also precluded use of non-nucleoside reverse transcriptase inhibitors. Introduction of an integrase-inhibitor regimen based on raltegravir, tenofovir, and emtricitabine allowed a prompt achievement of undetectable viral load and a substantial rise of CD4 count to high levels, with no subsequent episodes of hepatic toxicity, and no other side effects.


CONCLUSIONS
given the relatively common prevalence of HCV-related chronic hepatitis among people with HIV, raltegravir might represent an important alternative option for a substantial number of patients who cannot be treated with protease inhibitors or NNRTI because of drug-related hepatic toxicity.
Ortu
F
F
Clinic of Infectious Diseaes, Department of Medicine and Immunology, University of Cagliari, Italy.
Weimer
L E
LE
Floridia
Marco
M
Manconi
P E
PE
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000473:pathology; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology; D018655:Lymphocyte Count; D063065:Organophosphonates / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000009:adverse effects*; D011760:Pyrrolidinones / Q000627:therapeutic use*; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
D000998:Antiviral Agents; D063065:Organophosphonates; D011480:Protease Inhibitors; D011760:Pyrrolidinones; D003841:Deoxycytidine; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine
World J Gastroenterol. 2009 Aug 14;15(30):3713-24
19673011
AIDS. 2004 Nov 19;18(17):2277-84
15577540
Drugs. 2009 May 29;69(8):1059-75
19496631
N Engl J Med. 2008 Jul 24;359(4):339-54
18650512
HIV Clin Trials. 2008 Sep-Oct;9(5):309-13
18977719
Curr Opin HIV AIDS. 2007 Jul;2(4):293-8
19372901
J Antimicrob Chemother. 2010 Mar;65(3):543-7
20032006
AIDS Res Hum Retroviruses. 2006 Sep;22(9):825-9
16989605
HIV Clin Trials. 2006 Nov-Dec;7(6):319-23
17197379
Curr Opin HIV AIDS. 2007 Jul;2(4):306-13
19372904
Biomed Pharmacother. 2008 Jan;62(1):21-5
17223307
J Antimicrob Chemother. 2008 Apr;61(4):925-32
18276600
HIV Med. 2004 Sep;5(5):334-43
15369508
Lancet. 2007 Apr 14;369(9569):1261-1269
17434401