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Open Access Case report

Marked increase in etravirine and saquinavir plasma concentrations during atovaquone/proguanil prophylaxis

Chiara Tommasi1*, Rita Bellagamba1, Massimo Tempestilli1, Antonio D'Avolio2, Anna L Gallo1, Jelena Ivanovic1, Emanuele Nicastri1, Leopoldo P Pucillo1 and Pasquale Narciso

Author Affiliations

1 "National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149 Rome, Italy

2 Clinica Universitaria c/o Ospedale Amedeo di Savoia, University of Turin, Turin - Italy

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Malaria Journal 2011, 10:141  doi:10.1186/1475-2875-10-141

Published: 21 May 2011

Abstract

The case of a 32-year-old Caucasian female with multi-drug resistant HIV-1 subtype B infection treated with a salvage regimen including maraviroc, raltegravir, etravirine and unboosted saquinavir who started atovaquone/proguanil prophylaxis, is reported. The potential interactions between atovaquone/proguanil and these anti-retroviral drugs are investigated. Pharmacokinetic analyses documented a marked increase in etravirine and saquinavir plasma concentrations (+55% and +274%, respectively), but not in raltegravir and maraviroc plasma concentrations. The evidence that atovaquone/proguanil significantly interacts with etravirine and saquinavir, but not with raltegravir and maraviroc, suggests that the mechanism of interaction is related to cytochrome P450.