Crushed Raltegravir in an HIV Patient with a Perforated Rectosigmoid Colon Pages 58-60

Alvin B. Ounga, Yuliya Sergeyevaa, Tulip K. Schneidera,b, Andy Jeona, Christopher Spitzera and Joseph Bakerb

aMCPHS University, Boston, MA, USA; bFenway Health, Boston, MA, USA

DOI: http://dx.doi.org/10.12970/2309-0529.2014.02.02.4

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Abstract: Background: Since its approval as the first integrase inhibitor on the market, raltegravir has been well accepted for its potency in wild type and multi-drug resistant viruses, as well as its favorable side effect profile. However, current recommendations suggest that film-coated raltegravir tablets only be swallowed whole, making oral administration difficult in patients who would benefit from a crushed delivery, such as those with compromised absorption.

Methods: An HIV positive patient with a perforated rectosigmoid colon was instructed to crush his evening dose of raltegravir after finding intact tablets in his ostomy bag on several mornings. An HIV-1 RNA assay and CBC were ordered one week and four months after this observation to assess virologic suppression.

Results: The patient’s HIV-1 RNA viral load remained undetectable (<75 copies/mL) throughout treatment and had minimal changes in CD4 count: 1024 cells/mm3 prior to the observation, 1091 cells/mm3 one week after the observation, and 951 cells/mm3 four months after the observation. Patient noted good adherence, denied missing doses or experiencing any antiretroviral related side effects.

Conclusion: Crushed raltegravir is a viable and safe option for patients with compromised intestinal absorption.

Keywords: Raltegravir, crushed, perforated colon, ostomy, HIV, antiretroviral therapy, case report, administration, monitoring. Read more →