Severe insomnia related to high concentrations of raltegravir

aMedical Pharmacology and Toxicology Department, University Hospital Montpellier I, France bClinical Pharmacy Department, APHP Bichat-Claude Bernard Hospital and EA449 Paris 7 University, Paris, France cInfectious Diseases Department, University Hospital Montpellier I, France.
AIDS (London, England) (Impact Factor: 5.55). 03/2011; 25(5):725-7. DOI: 10.1097/QAD.0b013e32834465c8
Source: PubMed
10 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep disturbances are reportedly common among persons infected with human immunodeficiency virus (HIV), but recent data, including comparisons with HIV-uninfected persons, are limited. We performed a cross-sectional study among early-treated HIV-infected military beneficiaries (n = 193) to determine the prevalence and factors associated with insomnia (Pittsburgh Sleep Quality Index [PSQI]) and daytime sleepiness (Epworth Sleepiness Scale [ESS]). Data were compared with HIV-uninfected persons (n = 50) matched by age, sex, race or ethnicity, and military rank. Forty-six percent of HIV-infected persons had insomnia (PSQI >5), and 30% reported daytime drowsiness (ESS ≥10). The prevalence of insomnia and daytime sleepiness was not significantly higher compared with the HIV-uninfected group (38% [P = .30] and 20% [P = .18], respectively). In the multivariate model, factors associated with insomnia among HIV infected patients included depression (odds ratio [OR], 16.8; 95% confidence interval [CI], 2.0-142.1; P = .01), increased waist size (OR, 2.7; 95% CI, 1.4-5.1; P = .002), and fewer years of education (OR, 0.8; 95% CI, .7-.95; P = .006). Neurocognitive impairment (diagnosed in 19% of HIV-infected participants) was not associated with insomnia; however, HIV-infected persons with insomnia were 3.1-fold more likely to have a decline in activities of daily living than those without insomnia (23% vs 9%; P = .01). Only 18% of HIV-infected persons reported using a sleep medication at least weekly. HIV-infected persons have a high prevalence of insomnia, but among an early-treated cohort this rate was not significantly higher compared with HIV-uninfected persons. Factors associated with insomnia among HIV-infected patients include depression and increased waist size. Prompt diagnosis and treatment of sleep disturbances are advocated and may improve quality of life.
    Clinical Infectious Diseases 03/2012; 54(10):1485-94. DOI:10.1093/cid/cis192 · 8.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV-1 elite controllers (EC) spontaneously maintain suppressed levels of viremia, but exhibit significant immune activation. We investigated coronary atherosclerosis by coronary CT angiography (CTA) in: 1) EC, 2) non EC, chronically HIV-1 infected, ART-treated patients with undetectable viral load ("chronic HIV"), and 3) HIV-negative controls. Prevalence of atherosclerosis (78% vs. 42%, P < 0.05) and markers of immune activation were increased in EC compared to HIV-negative controls. sCD163, a monocyte activation marker, was increased in EC compared to chronic HIV-1 (P < 0.05) and compared to HIV-negative controls (P < 0.05). These data suggest a significant degree of coronary atherosclerosis and monocyte activation among EC.
    AIDS (London, England) 10/2012; 26(18). DOI:10.1097/QAD.0b013e32835a9950 · 5.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Central nervous system (CNS) symptoms have been reported in clinical trials and case reports in patients receiving raltegravir. We investigated CNS symptoms in 453 HIV-infected patients. Of these 47 (10.4%) developed at least one drug related CNS symptom. Predictors of CNS symptoms were concomitant therapy with tenofovir or with proton pump inhibitors which can increase raltegravir concentration. Thus, our data suggest a possible correlation between high raltegravir plasma concentrations and CNS symptoms and therefore their monitoring in clinical practice.
    AIDS (London, England) 10/2012; 26(18). DOI:10.1097/QAD.0b013e32835aa141 · 5.55 Impact Factor
Show more