Five years' real-life experience with raltegravir in a large HIV centre.
Raltegravir was the first licensed integrase inhibitor. Real-life experience is informative and complements trial data. We therefore evaluated raltegravir use in adults in a large HIV treatment centre. From pharmacy and departmental HIV database records, we identified all adults taking ≥1 dose of raltegravir from first availability to the end of November 2012. Data were collected using a standardised case report form. Two hundred and fifteen individuals provided 502 patient-years (median 2.6 years/person) of raltegravir use. Of 215 individuals, 166 (77%) were male, median age 43 years; 189 (88%) were antiretroviral therapy (ART)-experienced and 26 (12%) ART-naive, with median baseline CD4 counts of 324 and 54 cells/µL, respectively. Of ten individuals using once-daily raltegravir, four, with good adherence remained virologically suppressed after a median 28 months, four stopped against medical advice, one stopped to simplify and one failed virologically. In hepatitis co-infection, 35 individuals (92 patient-years) took raltegravir without evidence of hepatotoxicity. Six women started raltegravir during pregnancy for intensification (5/6) or switch for tolerability without complications. Of ten individuals stopping raltegravir after virological failure, 2/4 with successful sequencing showed resistance. Raltegravir appears safe and effective, without evidence of toxicity above that in published trials, including in pregnancy and co-infections. Once-daily dosing seems effective where adherence is good.
Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK claretaylor@doctors.org.uk clare.vanhalsema@nhs.net.
Clare
C
van Halsema
Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK.
Thomas
T
Whitfield
University of Manchester School of Medicine, Oxford Road, Manchester, UK.
Naomi
N
Lin
Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK.
Kathryn
K
Ashton
Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK.
Adele
A
Torkington
Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK.
Andrew
A
Ustianowski
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D019428:HIV Integrase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects*; D006525:Hepatitis, Viral, Human / Q000188:drug therapy; D006801:Humans; D008016:Life Change Events; D008297:Male; D011247:Pregnancy; D000068898:Raltegravir Potassium / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
D019428:HIV Integrase Inhibitors; D000068898:Raltegravir Potassium
AIDS; HAART (Highly Active Antiretroviral Therapy); HIV (Human immunodeficiency virus); antiviral; integrase inhibitor; raltegravir; toxicity; treatment; viral disease