Nelfinavir desensitization

OBJECTIVE: To report the first case of nelfinavir desensitization in an HIV patient who was intolerant to protease inhibitors. CASE SUMMARY: A 43-year-old HIV-positive white man was treated with several protease inhibitors. The patient developed rashes in response to all protease inhibitors. His viral load was controlled only in the presence of a protease inhibitor. The patient tolerated nelfinavir longer than the other agents; therefore, the decision was made to attempt to desensitize him to nelfinavir. A six-hour inpatient protocol was used, and he tolerated the procedure without event. His disease is now well managed without recurrence of the rash. DISCUSSION: The use of protease inhibitors has had a major impact on the morbidity and mortality of HIV-infected patients, Despite their benefits, this class of drugs is not without adverse effects. Allergic reactions in the form of rashes may develop, which can severely limit treatment options in HIV patients. We report the first case of rapid desensitization of nelfinavir in a patient who developed rashes to several protease inhibitors. CONCLUSIONS: Intolerance to protease inhibitors due to rash is a well-documented phenomenon. In HIV patients, this can limit treatment options severely. This case demonstrates how desensitization to nefinavir can be performed successfully.