Abstract：
OBJECTIVE: Preliminary evidence shows that concomitant administration of valproic acid can reduce the exposure to dolutegravir with limited clinical impacts. Here, we describe a male living with HIV who experienced a drastic reduction in dolutegravir trough concentrations a few weeks after starting valproic acid treatment as identified by therapeutic drug monitoring. Concomitantly, pharmacists recommended a supplementation of magnesium to improve insomnia.
METHODS: A 62-year-old man with HIV on antiretroviral therapy with dolutegravir and lamivudine recently added valproic acid to clonazepam and sertraline to treat severe sleep disturbances. An 84% reduction in dolutegravir trough concentrations was observed compared with the previous outpatient visit (418 versus 2714 ng/mL), with values close to the minimum effective drug concentration (300 ng/mL). Considering this, we strongly discourage the use of magnesium.
CONCLUSIONS: We are confident that our findings can contribute to a better understanding of the clinical problems that infectious disease physicians encounter in their daily management of people with HIV and how therapeutic drug monitoring may add value in this context. This case also highlights the importance of multidisciplinary services for the optimal management of polypharmacy in people with HIV.
METHODS: A 62-year-old man with HIV on antiretroviral therapy with dolutegravir and lamivudine recently added valproic acid to clonazepam and sertraline to treat severe sleep disturbances. An 84% reduction in dolutegravir trough concentrations was observed compared with the previous outpatient visit (418 versus 2714 ng/mL), with values close to the minimum effective drug concentration (300 ng/mL). Considering this, we strongly discourage the use of magnesium.
CONCLUSIONS: We are confident that our findings can contribute to a better understanding of the clinical problems that infectious disease physicians encounter in their daily management of people with HIV and how therapeutic drug monitoring may add value in this context. This case also highlights the importance of multidisciplinary services for the optimal management of polypharmacy in people with HIV.
摘要：
目的：初步证据表明，丙戊酸的同时给药可以减少多鲁特韦的暴露，但临床影响有限。这里,我们描述了一名感染HIV的男性患者,在开始丙戊酸治疗几周后,dolutegravir的药物浓度急剧下降.同时，药剂师建议补充镁来改善失眠。
方法：一名62岁的HIV感染者正在接受多鲁特韦和拉米夫定的抗逆转录病毒治疗，最近在氯硝西泮和舍曲林中加入丙戊酸治疗严重的睡眠障碍。与先前的门诊就诊（418对2714ng/mL）相比，观察到dolutegravir谷浓度降低了84％，值接近最低有效药物浓度（300ng/mL）。考虑到这一点,我们强烈反对使用镁。
结论：我们相信，我们的发现有助于更好地理解传染病医师在HIV感染者的日常管理中遇到的临床问题，以及治疗药物监测如何在这种情况下增加价值。此案例还强调了多学科服务对于HIV感染者中多种药物的最佳管理的重要性。
方法：一名62岁的HIV感染者正在接受多鲁特韦和拉米夫定的抗逆转录病毒治疗，最近在氯硝西泮和舍曲林中加入丙戊酸治疗严重的睡眠障碍。与先前的门诊就诊（418对2714ng/mL）相比，观察到dolutegravir谷浓度降低了84％，值接近最低有效药物浓度（300ng/mL）。考虑到这一点,我们强烈反对使用镁。
结论：我们相信，我们的发现有助于更好地理解传染病医师在HIV感染者的日常管理中遇到的临床问题，以及治疗药物监测如何在这种情况下增加价值。此案例还强调了多学科服务对于HIV感染者中多种药物的最佳管理的重要性。
