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HIV-2 Infection, End-Stage Renal Disease and Protease Inhibitor Intolerance

Which Salvage Regimen?

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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.

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Acknowledgements

The authors have no commercial or other associations that might pose a conflict of interest. No funding was received for this work.

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Authors and Affiliations

  1. Clinic of Infectious Diseases, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy

    Daniela Francisci, Laura Martinelli, Giulia Masini & Franco Baldelli

  2. Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy

    Liliana E. Weimer &  Marco Floridia

  3. Department of Molecular Biology, Section of Microbiology, University of Siena, Siena, Italy

    Maurizio Zazzi

Authors
  1. Daniela Francisci
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  2. Laura Martinelli
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  3. Liliana E. Weimer
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  4. Maurizio Zazzi
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  5. Marco Floridia
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  6. Giulia Masini
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  7. Franco Baldelli
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Corresponding author

Correspondence to Marco Floridia.

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Francisci, D., Martinelli, L., Weimer, L.E. et al. HIV-2 Infection, End-Stage Renal Disease and Protease Inhibitor Intolerance. Clin. Drug Investig. 31, 345–349 (2011). https://doi.org/10.1007/BF03256933

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  • DOI: https://doi.org/10.1007/BF03256933

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