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Raltegravir is a well-tolerated alternative third agent used in postexposure prophylaxis (PEP).1 ,2 In a single-centre study reviewing reasons for initiation and tolerability of raltegravir-PEP, we identified patients receiving PEP between February 2010 and April 2012. All patients receiving raltegravir-PEP were matched with standard-PEP controls (tenofovir-emtricitabine with lopinavir-ritonavir (LPV/r)). Ethical approval was not required as data was collected for service evaluation.
During this period 509 courses of PEP were prescribed, 33 (6.5%) containing raltegravir. Of the 61 cases analysed 66 (92%) were prescribed PEP following sexual exposure, 54/66 (82%) were male; 47/66 (71%) men who have sex with men. Of the 33 prescribed raltegravir-PEP, 19/33 (58%) were initiated at baseline: 15/19 (79%) owing to potential drug–drug interactions (DDIs), 3/19 (16%) owing to previous LPV/r intolerance and 1/19 (5%) owing to concerns of index HIV-resistance. Fourteen of 33 (42%) were initiated on standard-PEP but switched to raltegravir-PEP. Of these, 3/14 (21%) were switched due to DDIs missed at baseline and in 1/14 (7%) cases, raltegravir was added to LPV/r owing to index genotypical resistance concerns. Ten of 14 (30%) were switched to raltegravir due to intolerance of LPV/r. Three of 33 (9%) vs 0/33 (0%) experienced a significant rise in alanine transaminase and 28/33 (85%) vs 13/33 (39%) reported side effects during their treatment on standard versus raltegravir-PEP, respectively; 28/33 (85%) vs 0/33 (0%) reporting diarrhoea. Twelve of 14 (79%) switching from standard to raltegravir-PEP reported resolution of side effects. Seventeen of 33 (51%) vs 5/19 (26%) reported at least one late/missed dose on standard versus raltegravir-PEP. No patient experienced HIV seroconversion over the 3 months following PEP.
This small observational study supports raltegravir use as first line in PEP, highlighting the issue of DDIs with protease inhibitors used in PEP, DDIs being the most frequent reason for prescribing raltegravir (55% of cases), a proportion of which were missed at initiation. Despite an expected reduction in DDIs with first-line use of raltegravir-PEP, it remains important that prescribing clinicians continue to review concomitant medications at each visit, as interactions with commonly used medications still exist with raltegravir.
Footnotes
Contributors All authors have contributed significantly towards data collection or analysis and interpretation All authors have contributed significantly towards drafting the work and approval of the final version and agree to be accountable for all aspects of the work. The authors wish to express their deep appreciation of the late Professor Martin Fisher who assisted in drafting and critical revision of this project.
Competing interests LM has received sponsorship from Gilead and Janssen to attend conferences and courses. DR has received sponsorship from Gilead and Janssen to attend conferences, and from Viiv for lecturing. DA has received sponsorship from MSD to attend a conference.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement The data analysed in this study was presented at the 11th International Congress on Drug Therapy in HIV Infection, Glasgow 2012 and the British Association of Sexual Health and HIV (BASHH) spring conference, Bristol 2013. The abstract presented in Glasgow can be found at http://www.jiasociety.org/index.php/jias/article/view/18165.