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 prote ase inhibitors. His viral load was controlled only in the presence of a pro tease inhibitor. The patient tolerated nelfinavir longer than the other age nts; therefore, the decision was made to attempt to desensitize him to nelf inavir. A six-hour inpatient protocol was used, and he tolerated the proced ure without event. His disease is now well managed without recurrence of th e rash. DISCUSSION: The use of protease inhibitors has had a major impact on the mo rbidity acid mortality of HIV-infected patients. Despite their benefits, th is 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 nelfinav ir in a patient who developed rashes to several protease inhibitors, CONCLUSIONS: Intolerance to protease inhibitors due to rash is a well-docum ented phenomenon. In HIV patients, this can limit treatment options severel y. This case demonstrates how desensitization to nelfinavir can be performe d successfully.