title: HIV-2 infection, end-stage renal disease and protease inhibitor intolerance: which salvage regimen?
abstract: Non-nucleoside reverse transcriptase inhibitors and enfuvirtide are ineffective against HIV-2 replication. These considerations may have particular significance in the formulation of second-line or salvage regimens for HIV-2 infection when resistance or toxicity precludes the use of protease inhibitors (PIs) or specific nucleoside analogues. We describe a case of a treatment-experienced patient with important limitations in therapeutic options dictated by the presence of HIV-2 infection, severe HIV nephropathy (requiring haemodialysis), intolerance to PIs and clinical contraindications to the use of some nucleoside analogues (anaemia, pancreatic toxicity and high cardiovascular risk). A three-drug regimen based on raltegravir, tenofovir disoproxil fumarate and lamivudine was given, with no major toxicity, good immunological response and complete viral suppression. Our case indicates that regimens based on integrase inhibitors could represent an effective alternative in PI-resistant or PI-intolerant patients with HIV-2, and that tenofovir disoproxil fumarate may be used in patients with end-stage renal disease requiring haemodialysis who cannot take other nucleoside analogues because of treatment-limiting adverse effects.
authors.affiliation: Clinic of Infectious Diseases, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Laura
authors.initials: L
authors.lastname: Martinelli
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Weimer
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zazzi
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
authors.forename: Giulia
authors.initials: G
authors.lastname: Masini
authors.forename: Franco
authors.initials: F
authors.lastname: Baldelli
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015498:HIV-2 / Q000302:isolation & purification; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000628:therapy; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use; D011760:Pyrrolidinones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000068898:Raltegravir Potassium; D006435:Renal Dialysis; D016879:Salvage Therapy; D000068698:Tenofovir; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D011480:Protease Inhibitors; D011760:Pyrrolidinones; D019259:Lamivudine; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D000225:Adenine