Raltegravir

How it works

It inhibits HIV integrase, preventing integration of viral DNA into the host genome and thereby blocking establishment of productive infection.

Prescribing in practice

• Always use within a fully suppressive combination antiretroviral regimen; never as monotherapy, as resistance develops rapidly.
• Polyvalent cation-containing antacids and certain supplements can chelate the drug and reduce absorption, so separate administration carefully.
• Rare but serious skin and hypersensitivity reactions, including severe cutaneous reactions, have been reported.

Monitoring

Monitor HIV viral load and CD4 count to confirm virological response, alongside periodic liver function and creatine kinase if myopathy is suspected.

Counselling the patient

• Take every dose as prescribed to keep the virus suppressed and prevent resistance.
• Tell your clinician about any antacids, indigestion remedies or mineral supplements before starting.
• Seek urgent advice if you develop a rash, fever or muscle pain.

Evidence & guidelines

Raltegravir is a recommended first-line INSTI option in UK and international HIV treatment guidelines.