title: A reduced grade of liver fibro-steatosis after raltegravir, maraviroc and fosamprenavir in an HIV/HCV co-infected patient with chronic hepatitis, cardiomyopathy, intolerance to nelfinavir and a marked increase of serum creatine phosphokinase levels probably related to integrase inhibitor use.
abstract: The use of new antiretroviral drugs in HIV infection is particularly important in patients with intolerance or resistance to other antiretroviral agents. Raltegravir and maraviroc represent new, important resources in salvage regimens. A reduced grade of liver fibro-steatosis after a combination of raltegravir and maraviroc (second-line) has not been studied and the mechanism by which these new drug classes induced a marked reduction of grade of liver diseases is currently unknown. In the present case report, nested in an ongoing multicentre observational study on the use of new antiretroviral inhibitors in heavy treatment-experienced HIV patients, we evaluated the correlation between a "short therapeutic regimen" raltegravir maraviroc and fosamprenavir and liver diseases. The aim of this report is to describe the use of a three-drug regimen based on two novel-class antiretroviral agents (raltegravir and maraviroc) plus the protease inhibitor fosamprenavir, in an experienced HIV-infected patient with chronic progressive hepatitis C complicated by liver fibrosis; an overwhelming increased serum creatine kinase level occurred during treatment, and is probably related to integrase inhibitor administration. At present no information is available regarding this correlation.
authors.affiliation: Department of Immunology, University of Parma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Degli Antoni
authors.forename: L E
authors.initials: LE
authors.lastname: Weimer
authors.forename: R
authors.initials: R
authors.lastname: Manfredi
authors.forename: V
authors.initials: V
authors.lastname: Fragola
authors.forename: C
authors.initials: C
authors.lastname: Ferrari
mesh_terms: D000328:Adult; D002219:Carbamates / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000188:drug therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D003402:Creatine Kinase / Q000097:blood*; D003510:Cyclohexanes / Q000009:adverse effects* / Q000627:therapeutic use; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000139:chemically induced* / Q000175:diagnosis; D005663:Furans; D023581:HIV Fusion Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy*; D019428:HIV Integrase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D000077592:Maraviroc; D010755:Organophosphates / Q000009:adverse effects* / Q000627:therapeutic use; D011760:Pyrrolidinones / Q000009:adverse effects* / Q000627:therapeutic use; D000068898:Raltegravir Potassium; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002219:Carbamates; D003510:Cyclohexanes; D005663:Furans; D023581:HIV Fusion Inhibitors; D019428:HIV Integrase Inhibitors; D017320:HIV Protease Inhibitors; D010755:Organophosphates; D011760:Pyrrolidinones; D013449:Sulfonamides; D014230:Triazoles; D000068898:Raltegravir Potassium; D003402:Creatine Kinase; D000077592:Maraviroc; C426859:fosamprenavir