Optimal use of raltegravir (Isentress(R)) in the treatment of HIV-infected adults - Canadian consensus guidelines.
OBJECTIVE
A meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV-treating physicians on the appropriate use of raltegravir (MK-0518, Isentress(R), Merck Frosst Canada Inc) in HIV-infected adults.


METHODS
Evidence from the published literature and conference presentations, as well as expert opinions of the group members, was considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from five other physicians and scientists across Canada with expertise in HIV treatment and antiretroviral drug resistance, and experience in the use of raltegravir. The final recommendations represent the core group's consensus agreement once all feedback was considered.


CONCLUSIONS
Recommendations were developed to guide physicians in the optimal use of raltegravir. The issues considered included raltegravir's role in overall treatment strategy, efficacy, durability of effect, rate of viral load reduction, resistance, safety/toxicity, pharmacokinetics and drug interactions.
Rachlis
Anita
A
Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto;
Angel
Jonathan B
JB
Harris
Marianne
M
Shafran
Stephen D
SD
Therrien
Rachel
R
Tremblay
Cécile
C
Wainberg
Mark A
MA
HIV Med. 2008 Oct;9(8):563-608
18826546
JAMA. 2008 Aug 6;300(5):555-70
18677028
J Clin Pharmacol. 2008 Jun;48(6):726-33
18441333
Clin Infect Dis. 2008 Jul 1;47(1):137-40
18513146
N Engl J Med. 2008 Jul 24;359(4):339-54
18650512
Nat Rev Drug Discov. 2005 Mar;4(3):236-48
15729361
Clin Infect Dis. 2008 Jul 15;47(2):266-85
18549313
Antimicrob Agents Chemother. 2008 Dec;52(12):4338-43
18838589
Lancet. 2008 Jul 26;372(9635):293-9
18657708
J Clin Pharmacol. 2008 Feb;48(2):209-14
18077730
Annu Rev Pharmacol Toxicol. 2009;49:377-94
18928385
PLoS Med. 2008 Jul 29;5(7):e164
18666826
Lancet. 2006 Aug 5;368(9534):466-75
16890833
J Antimicrob Chemother. 2009 Apr;63(4):795-804
19221102
N Engl J Med. 2008 Jul 24;359(4):355-65
18650513
Lancet. 2007 Jul 7;370(9581):29-38
17617270
Antimicrob Agents Chemother. 2008 Sep;52(9):3253-8
18625763
AIDS. 2007 Nov 12;21(17):2315-21
18090280
AIDS. 2008 Jul 11;22(11):1382-4
18580624
AIDS. 2008 Oct 18;22(16):2097-106
18832873
J Acquir Immune Defic Syndr. 2006 Dec 15;43(5):509-15
17133211
AIDS. 2008 Feb 19;22(4):547-8
18301075
Science. 2000 Jan 28;287(5453):646-50
10649997
J Infect Dis. 2008 Apr 15;197(8):1133-44
18476292
AIDS. 2008 Jun 19;22(10):1224-6
18525270
J Antimicrob Chemother. 2008 Nov;62(5):914-20
18718922
J Acquir Immune Defic Syndr. 2002 May 1;30(1):105-10
12048370
AIDS Patient Care STDS. 2007 Aug;21(8):533-43
17711378
Expert Opin Investig Drugs. 2008 Jan;17(1):97-103
18095922
HIV Med. 2007 Oct;8(7):427-32
17760734
AIDS. 2008 Sep 12;22(14):1890-2
18753871
Antimicrob Agents Chemother. 2009 Jul;53(7):2752-5
19398643
Ann Pharmacother. 2008 Jul;42(7):1048-59
18577765
Lancet. 2007 Apr 7;369(9568):1169-78
17416261
J Acquir Immune Defic Syndr. 2009 Aug 1;51(4):367-73
19487951
AIDS. 2008 May 31;22(9):1091-2
18520356
Lancet. 2007 Apr 14;369(9569):1261-1269
17434401
J Acquir Immune Defic Syndr. 2007 Oct 1;46(2):125-33
17721395
Expert Rev Anti Infect Ther. 2007 Feb;5(1):67-75
17266455
Drug Metab Dispos. 2004 Nov;32(11):1201-8
15304429
Antimicrob Agents Chemother. 2008 Apr;52(4):1351-8
18227187
Top HIV Med. 2008 Apr-May;16(1):62-8
18441382
Clin Pharmacol Ther. 2008 Feb;83(2):293-9
17713476
Drug Metab Dispos. 2007 Sep;35(9):1657-63
17591678
Antiviral Res. 2008 Nov;80(2):213-22
18625269
AIDS. 2008 Oct 18;22(16):2187-98
18832882