Dolutegravir/emtricitabine/tenofovir alafenamide
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Immune reconstitution inflammatory syndrome: case report A 41-year-old man developed immune reconstitution inflammatory syndrome during treatment with dolutegravir, emtricitabine and tenofovir alafenamide for HIV/AIDS. The man, who was recently diagnosed with HIV/AIDS and Pneumocystis jirovecii pneumonia (PCP) was admitted with 5 days of fever, headache, throat pain and dry cough. Six weeks prior to the admission, work-up revealed a CD4 count of 88 cells/µL, and was diagnosed with PCP. He had started receiving antiretroviral therapy with dolutegravir, emtricitabine and tenofovir alafenamide [dosages and routes not stated] along with concomitant cotrimoxazole [trimethoprim/sulfamethoxazole] and prednisone taper. Examination on admission showed fever and tachycardia. Physical examination showed small white palatal lesions (thrush), and a healing rash on the lower extremities. Laboratory test showed CD4 count of 138 cells/µL. He had mild transaminitis with an increased LDH, which resolved during the hospital course. Chest CT scan showed diffuse lymphadenopathy. Based on the initial presentation, the man started receiving empirical therapy with unspecified antibacterials to cover PCP pneumonia. A broad infectious work-up including blood, urine, sputum culture, brain MRI with contrast and lumber puncture with CSF analysis and culture was negative for any causative organism. Sliver stain for PCP pneumonia was negative. Based on consultation with infectious disease specialists, a diagnosis of immune reconstitution inflammatory syndrome secondary to antiretroviral therapy was made [durations of treatments to reaction onset not stated]. He was stabilised and discharged home with recommendations to continue his antiretroviral regimen and to follow-up as an outpatient. Author comment: "After consultation with infectious disease specialists, a diagnosis of immune reconstitution inflammatory syndrome (IRIS) secondary to the initiation of [antiretroviral therapy] was reached." Kissee R, et al. Haart attack: Diagnosing fever in HIV. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 483, No. 4, Apr 2018. Available from: URL: https:// www.shmabstracts.com/abstract/haart-attack-diagnosing-fever-in-hiv/ [abstract] 803432141 USA
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Reactions 9 Nov 2019 No. 1778
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