Raltegravir plus Two Nucleoside Analogues as Combination Antiretroviral Therapy in HIV-Infected Patients who Require Cancer Chemotherapy

Casado, José L.; Machuca, Isabel; Bañón, Sara; Moreno, Ana; Moltó, José; Rodríguez, Miguel Ángel Palomero

doi:10.3851/imp2961

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…In theory, integrase inhibitors (IIs) are eligible while these agents do not interfere with the CYP enzyme system and therefore no alternations in pharmacokinetics and exposure to toxic metabolites are expected. This approach has recently been suggested by a German as well as by an American HIV-treatment group and is supported by a report on a small cohort of Spanish HIV-positive patients undergoing safe and effective chemotherapy while on raltegravir based cART [ 26 – 28 ]. A prospective study of the use of II’s versus NNRTI`s or PI`s is highly recommended.…”

Section: Discussionmentioning

confidence: 93%

Outcome effects of antiretroviral drug combinations in HIV-positive patients with chemotherapy for lymphoma: a retrospective analysis

et al. 2018

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Background The combination of combined active antiretroviral therapy (cART) with chemotherapy in the treatment of lymphoma in human immunodeficiency virus (HIV)-positive patients has improved the overall survival of these patients. However, drug–drug interactions between antineoplastic agents and the antiretroviral agents non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) can occur by influencing the activity of the CYP3A4 enzyme. So far, little is known about the clinical relevance of this interaction: the effect on the efficacy and toxicity of the chemotherapy. Also, there is no general consensus which cART is preferable in combination with antineoplastic drugs. Objective To compare PI-based with NNRTI-based cART on the efficacy and toxicity of chemotherapy in lymphoma patients. Setting The Onze Lieve Vrouwe Gasthuis, located in Amsterdam, The Netherlands. Method A retrospective observational cohort study including all patients with HIV and lymphoma over a 10-year period. Clinical outcome (response to chemotherapy and survival) and toxicity of chemotherapy (renal, hepatic and bone marrow toxicity as well as dose reduction, treatment delay and discontinuation) was compared in patients with PI based and NNRTI-based cART. Main outcome measure: Response to chemotherapy and survival. Results Patients using PI-based cART (n = 22) had a significantly lower 1 year survival compared to NNRTI-based cART (n = 21). No significant differences were observed in reaching complete remission after chemotherapy. No overall significant differences in toxicity and discontinuation of the chemotherapy were observed. However, there was a trend towards more severe bone-marrow toxicity in patients with PI-based cART. In addition, patients with PI-based cART received earlier dose-reduction and treatment delay, indicating increased toxicity in PI-treated patients. Conclusion This retrospective study shows that PI-based cART is inferior in combination with chemotherapy to NNRTI-based cART: a lower 1 year survival is observed and dose-reduction and treatment delay occur earlier, possibly based on an earlier onset of toxicity.

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Section: Discussionmentioning

confidence: 93%

Outcome effects of antiretroviral drug combinations in HIV-positive patients with chemotherapy for lymphoma: a retrospective analysis

et al. 2018

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“…This can lead to increased toxicity and a potential delay in chemotherapy treatments. In this setting, non-boosted integrase inhibitors are increasingly being used due to a more favorable drug-drug interaction profile and better tolerability [23,24], as observed in our cohort. Although this may have impact on the In this study, patients with HIV and cancer experienced higher mortality than those without HIV.…”

Section: Discussionmentioning

confidence: 58%

Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study

et al. 2021

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Introduction: We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality. Methods: BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected . A case (HIV-infected)-control (non-HIV-infected) subanalysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism. Results: From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had\200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease (p\0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV (p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently (p = 0.014) and had higher mortality José M. Miró and Carolina Garcia-Vidal have equivalent merits as senior authors.

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“…35,36 One observational cohort study of 30 patients who initiated or were changed to a raltegravir-based ART as a result of a cancer diagnosis showed a mean increase in CD4 count of 49 cells/mL; only 1 discontinuation as a result of virological failure, which was attributed to nonadherence; and no additive adverse effects attributed to ART. 35 A retrospective study in 154 patients that compared various HIV regimens showed that INSTI-based treatment was 9 times (95% CI = 1.4-50.8) more likely to be effective, as shown by HIV RNA <200 copies/mL at 6 months, than PI-based treatment. 36 Adverse effects related to ART occurred in 35% (17/49) of patients receiving PIs and 3% (1/30) of patients receiving INSTIs.…”

Section: Initiation/continuation Of Artmentioning

confidence: 99%

Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

et al. 2019

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Objective: To describe data with selected malignancies in people living with HIV (PLWH) and HIV in individuals affected by both conditions and to summarize drug-drug interactions (DDIs) with clinical recommendations for point-of-care review of combination therapies. Data Sources: Literature searches were performed (2005 to December 2018) in MEDLINE and EMBASE to identify studies of malignancies in PLWH in the modern era. Study Selection and Data Extraction: Article bibliographies and drug interaction databases were reviewed. Search terms included HIV, antiretroviral therapy, antineoplastic agents, malignancies, and drug interactions. Data Synthesis: In the pre–antiretroviral therapy (ART) era, malignancies in PLWH were AIDS-defining illnesses, and life expectancy was shorter. Nowadays, PLWH are living longer and developing malignancies, including lung, anal, and prostate cancers. Concurrently, the oncology landscape has evolved, with novel oral targeted agents and immunotherapies becoming routine elements of care. The increased need for and complexity with antineoplastics in PLWH has led to recommendations for multidisciplinary care of this unique population. Evaluation of DDIs requires review of metabolic pathways, absorption mechanisms, and various drug transporters associated with antineoplastics and ART. Relevance to Patient Care and Clinical Practice: This review summarizes available data of non–AIDS-defining malignancies, principles of HIV care in the patient with malignancy, and guidance for assessing DDIs between antineoplastics and ART. Summary DDI tables provide point-of-care recommendations. Conclusions: The availability of ART has transformed AIDS into a chronic medical condition, and PLWH are experiencing age-related malignancies. Pharmacists play an important role in the management of this patient population.

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Raltegravir plus Two Nucleoside Analogues as Combination Antiretroviral Therapy in HIV-Infected Patients who Require Cancer Chemotherapy

Abstract: Our results show that a RAL-based regimen is safe and effective in patients requiring chemotherapy, irrespective of type and of duration of chemotherapy.

Cited by 10 publications

References 20 publications

Outcome effects of antiretroviral drug combinations in HIV-positive patients with chemotherapy for lymphoma: a retrospective analysis

Outcome effects of antiretroviral drug combinations in HIV-positive patients with chemotherapy for lymphoma: a retrospective analysis

Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study

Managing Pharmacotherapy in People Living With HIV and Concomitant Malignancy

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