Tolerability of HIV postexposure prophylaxis with tenofovir/emtricitabine and lopinavir/ritonavir tablet formulation

Tosini, William; Müller, Philippe; Prazuck, Thiérry; Benabdelmoumen, G.; Peyrouse, Eric; Berthou, Christian; Quertainmont, Yann; Bouvet, E.; Rabaud, Christian

doi:10.1097/qad.0b013e32833dfad1

Cited by 46 publications

(35 citation statements)

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“…Geralmente, todos esses efeitos são de intensidade leve a moderada e autolimitados, como observado no caso relatado, devendo ser recomendado apenas o uso de medicamentos sintomáticos, quando necessário. Ainda assim, a taxa de descontinuação dos antirretrovirais devido a eventos adversos nos estudos de PEP tem variado de 11,7 a 21% [6][7][8] . As alterações laboratoriais são geralmente discretas, transitórias e pouco frequentes 3 .…”

Section: Discussionunclassified

“…Nesses casos, convém que o médico do trabalho consulte um especialista quanto à necessidade de substituição do TDF. Embora dois estudos de tolerabilidade da PEP contendo TDF não tenham demonstrado aumento dos níveis de creatinina nos indivíduos expostos 6,7 , há relato de insuficiência renal aguda e síndrome de Fanconi em uma pessoa previamente hígida após 16 dias do início da PEP contendo TDF e um inibidor de protease potencializado com RTV 12 . Deve-se considerar também o risco de exacerbação aguda grave da hepatite após término da profilaxia com TDF e 3TC quando o trabalhador exposto tiver infecção pelo vírus da hepatite B. Entretanto, o início da PEP não deve ser retardado se o status sorológico do trabalhador não for conhecido.…”

Section: Discussionunclassified

“…Já foram documentados casos graves de síndrome de Stevens-Johnson e eritema multiforme com uso do ATV na terapia antirretroviral. Mas os casos de exantema relacionado à profilaxia com TDF e ATV foram benignos e resolvidos com a suspensão das drogas 7,13 , cabendo ao médico do trabalho, mais uma vez, tranquilizar e orientar os trabalhadores para que completem a profilaxia.…”

Section: Discussionunclassified

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Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Alverca¹,

Quixabeiro²,

Martins³

2018

Rev. Bras. Med. Trab.

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RELATO DE CASORESUMO | A exposição ocupacional a material biológico com risco de transmissão do vírus da imunodeficiência humana (HIV) constitui uma emergência médica. A profilaxia pós-exposição (PEP) deve ser iniciada precocemente e mantida por 28 dias. Desde julho de 2015, o Ministério da Saúde passou a recomendar o uso combinado de três drogas antirretrovirais para a PEP, menos tóxicas e melhor toleradas do que as usadas anteriormente. Apesar disso, quase metade dos expostos em uso da PEP apresenta efeitos adversos. Geralmente, eles são leves e autolimitados. Os mais comuns são alterações gastrointestinais, astenia, cefaleia e tontura. Entretanto, eventos mais graves já foram observados e a taxa de interrupção da profilaxia permanece elevada. Em 2017, o Ministério da Saúde modificou o esquema de primeira linha da PEP, substituindo o terceiro antirretroviral. Esse artigo relata um caso de toxicidade associada ao uso da PEP após exposição ocupacional a material biológico contaminado pelo HIV, traz a revisão dos potenciais efeitos adversos das drogas antirretrovirais que compõem o esquema profilático preconizado pelo Ministério da Saúde e discute a conduta do médico do trabalho diante dessas complicações. Palavras-chave | exposição ocupacional; profilaxia pós-exposição; efeitos colaterais e reações adversas relacionados a medicamentos; antirretrovirais.ABSTRACT | Occupational exposure to biological materials involving risk of human immunodeficiency virus (HIV) transmission is a medical emergency. Post-exposure prophylaxis (PEP) should be started early and administered for 28 days. Since July 2015, the Brazilian Ministry of Health recommends the combined use of three antiretroviral drugs for PEP, which are less toxic and better tolerated than the ones previously used. Nevertheless, almost half of the exposed individuals under PEP exhibit adverse effects, which are usually mild and self-limited. The most frequent adverse events are gastrointestinal disorders, asthenia, headache and dizziness. However, more severe events have been reported, and the rate of non-completion of prophylaxis remains high. In 2017, the Brazilian Ministry of Health modified the first-line PEP regimen involving replacement of the third antiretroviral drug. The present article reports a case of toxicity associated with PEP following an occupational accident involving exposure to HIV infected biological material. In addition, we review the potential adverse effects of antiretroviral drugs included in the prophylactic regimens recommended by the Brazilian Ministry of Health and discuss measures occupational physicians should adopt vis-à-vis these complications.

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Section: Discussionunclassified

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Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Alverca¹,

Quixabeiro²,

Martins³

2018

Rev. Bras. Med. Trab.

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“…In a tolerability study of 166 patients that completed 30 days of HIV post-exposure prophylaxis with tenofovir/ emtricitabine and lopinavir/ritonavir, there was only one instance of rhabdomyolysis. 3 This occurred in a 32-year-old female that presented with myalgias and elevated creatine kinase (CK) level, 10 days after initiating tenofovir/emtricitabine and lopinavir/ritonavir. However, AKI was not reported in this case.…”

Section: Introductionmentioning

confidence: 99%

“…The International AIDS Society currently recommends instituting therapy for HIV-positive individuals when the CD4 count drops below 500/mm 3 . 1 As highly active antiretroviral therapy (HAART) is being instituted at a higher CD4 count, the side effects of these agents must be readily detectable by the clinician given that more HIV-positive patients will be on these medications.…”

Section: Introductionmentioning

confidence: 99%

Severe recurrent rhabdomyolysis-induced acute kidney injury in a HIV-infected patient on antiretroviral therapy

2013

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Antiretroviral medications, specifically tenofovir, have been linked to acute tubular necrosis in humans with a suggested mechanism of direct tubular injury. Rhabdomyolysis has rarely been described in patients on highly active antiretroviral therapy (HAART). To the best of our knowledge, severe recurrent rhabdomyolysis-induced acute kidney injury (AKI) in a HIV-infected patient on two different triple antiretroviral regimens has not been reported. We present a HIV-positive patient who first developed heme pigment-induced oliguric AKI due to non-traumatic rhabdomyolysis, 5 days after initiation of triple antiretroviral therapy. Renal function normalized 2 months after discontinuation of antiretroviral therapy. Two weeks after reinitiating a different HAART regimen, our patient developed a recurrent episode of severe rhabdomyolysis-induced AKI. Both rhabdomyolysis and AKI resolved after discontinuation of the second antiretroviral regimen. First tenofovir and subsequently abacavir seem to be the likely culprits in our case. We also briefly discuss tenofovir nephrotoxicity followed by a literature review on rhabdomyolysis in HIV-infected patients.

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Management of Needlestick Injuries

Henderson¹

2012

JAMA

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Since its identification in 1985, human immunodeficiency virus (HIV) has challenged several aspects of health care delivery. Because HIV is a blood-borne infectious disease, from the early days of the epidemic, concern was raised about risks of occupational exposures and infections among health care workers. Despite the development of highly active antiretroviral therapy, which has effectively modulated HIV into a chronic disease in many settings, risks of occupational infection with 3 blood-borne pathogens remain in the health care workplace. Using the case of a house officer who has a needlestick during a resuscitation attempt, prevention of needlesticks including universal precautions and postexposure management of occupational HIV, hepatitis B, and hepatitis C exposures is discussed.

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Tolerability of HIV postexposure prophylaxis with tenofovir/emtricitabine and lopinavir/ritonavir tablet formulation

Cited by 46 publications

References 5 publications

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Severe recurrent rhabdomyolysis-induced acute kidney injury in a HIV-infected patient on antiretroviral therapy

Management of Needlestick Injuries

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