Maraviroc

INTRODUCTION

Indications

HIV infection (with other antiretrovirals), specifically in patients with only CCR5-tropic HIV-1 detectable, with evidence of viral replication and HIV-1 strains displaying multiple resistance to other antiretrovirals. Use should be determined by treatment history and tropism testing.

Action

Blocks a specific receptor on CD-4 and T-cell surfaces which prevents CCR5-tropic HIV-1 from entering. Therapeutic Effects: Decreased invasion of CD-4 and T-cells by CCR5-tropic HIV-1 virus resulting in viral replication.

Adverse Reactions/Side Effects

CNS: dizziness. Resp: cough, upper respiratory tract infection. GI: abdominal pain, appetite disorder, HEPATOTOXICITY. Derm: RASH. MS: musculoskeletal pain. Misc: ALLERGIC REACTIONS, fever, immune reconstitution syndrome, ↑ risk of infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of liver toxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of an unusually aggressive immune reaction to opportunistic infection (immune reconstitution syndrome). Signs include fever, pain, warmth and redness and swelling at the site of infection. Notify physician of these signs immediately.

• Assess for signs of upper respiratory tract infection, including cough, fever, difficulty breathing, shortness of breath, increased sputum production, and malaise/fatigue. Report these signs to the physician or nursing staff.

• Assess any musculoskeletal pain, muscle tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may represent drug-induced myopathy, and advise the patient that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and prevent muscle wasting associated with HIV infection and AIDS.

Patient/Client-Related Instruction

• Emphasize the importance of taking maraviroc as directed even if the patient is asymptomatic, and that this drug must always be used in combination with other antiretroviral drugs. Do not take more than prescribed amount, and do not stop taking without consulting health care professional.

• Inform patient that maraviroc does not cure HIV or AIDS or ...