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Volume 49, Number 2, April 2016

Rapid onset of rhabdomyolysis after switching to a raltegravir-based antiretroviral regimen 

Wan-Jung Tsai, Susan Shin-Jung Lee, Hung-Chin Tsai, Cheng-Len Sy, Jui-Kuang Chen, Kuang-Sheng Wu, Yung-Hsin Wang, Yao-Shen Chen


Corresponding author:

Corresponding author. Susan Shin-Jung Lee, Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. 


Background and purpose: 

Raltegravir is the first integrase inhibitor antiretroviral agent that has been demonstrated to have antiviral efficacy and safety. However, the US Food and Drug Administration has recommended use with caution in patients with risk factors for rhabdomyolysis, based on four case reports of rhabdomyolysis in patients with identifiable risk factors. We present a 32-year-old Asian man with human immunodeficiency virus (HIV), but without other underlying diseases, who developed rapid-onset, raltegravir-associated rhabdomyolysis and hyperlactatemia. Our patient lacked predisposing factors for rhabdomyolysis, and the rapid onset time of 4 days was the shortest reported. Therefore, clinicians should exercise caution when using raltegravir and closely monitor all patients for the symptoms of muscle pain and weakness. This case has been reported to the National Adverse Drug Reactions Reporting System of the Department of Health in Taiwan.