Open AccessRaltegravir‐based post‐exposure prophylaxis (PEP): a safe, well‐tolerated alternative regimen
Author(s) -
Annandale D,
Richardson C,
Fisher M,
Richardson D
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18165
Subject(s) - raltegravir , medicine , emtricitabine , ritonavir , regimen , tolerability , pharmacology , adverse effect , virology , human immunodeficiency virus (hiv) , viral load , antiretroviral therapy
Three‐drug regimens are routinely recommended in the UK for PEP after possible high‐risk exposure to HIV. The current Department of Health and British Association for Sexual Health and HIV first‐line regimen is lopinavir/ritonavir, tenofovir and emtricitabine (Truvada). Raltegravir‐based regimens may be used as an alternative. This is a review of the use of raltegravir‐containing PEP to identify why and when this is initiated and its tolerability and safety compared to first‐line PEP. From February 2010 to April 2012, 509 courses of PEP were prescribed; 33 (6.5%) raltegravir‐containing PEP. Pharmacy records identified eligible patients; these were compared to 33 courses of first‐line PEP in the same time period. 18/33 (54%) of raltegravir‐containing PEP were initiated due to potential drug‐drug interactions with ritonavir, 3/33 (10%) due to the resistance profile of the contact and 12/33 (36%) due to intolerance of first‐line regimen. All switches to raltegravir‐based PEP occurred by day 3 of the course with 83% identified on day 1. All switches to raltegravir‐containing PEP due to the resistance profile of the contact took place by day 3 of the course. Patients switching due to drug intolerance was largely due to gastrointestinal side effects between days 1 to 16; 2 cases were due to ALT changes. 19 courses of raltegravir‐containing PEP were commenced on day one. Reported side effects in the raltegravir‐containing PEP were lower than courses of first‐line PEP: 10/19 (53%) patients reported no side effects by day 28 treatment compared to 5/33 (15%) patients on first‐line PEP. 12/14 (79%) patients on first‐line PEP who were switched to raltegravir‐containing PEP reported improvement in their side effects. There were no significant liver or renal toxicities in the raltegravir group; 3 patients on first‐line PEP had a significant ALT rise. One patient who started first‐line PEP was found to be HIV‐positive at baseline. An MSM who received raltegravir‐containing PEP seroconverted 4.5 months after the course of PEP. He reported 3 episodes of unsafe sexual behaviour since PEP. Raltegravir‐based regimens are safe and as well tolerated when compared to first‐line regimen. Switching to raltegravir‐based regimen is associated with a decrease in reported side effects. Self‐reported adherence is better if patients are started on raltegravir. This study suggests that raltegravir‐based PEP may be a preferred first‐choice regimen.