Makindo Medical Notes

💉 About

Enfuvirtide is a synthetic fusion inhibitor used in HIV management — a subcutaneous peptide that blocks viral entry into host cells. It is very expensive and reserved for treatment-experienced patients with resistance to multiple antiretroviral classes. Always 🔗 check the BNF entry for current dosing, cautions, and interactions.

🧠 Mode of Action

• Enfuvirtide binds to the gp41 subunit of the HIV envelope glycoprotein.
• This prevents the conformational change required for fusion of the viral and host cell membranes.
• As a result, HIV cannot enter CD4⁺ T-cells, halting infection of new cells.

📋 Indications & Dose

• Used in combination ART for HIV-1 infection in adults and children ≥6 years with extensive drug resistance.
• Given by subcutaneous injection twice daily (SC BD).
• Supplied as a lyophilised powder reconstituted before injection.

⚠️ Interactions

• No major CYP-mediated interactions; safe with most ART regimens.
• Check for potential immunomodulator interactions in the BNF.

🚧 Cautions

• Injection-site reactions are very common; rotate injection sites to reduce risk.
• Use with caution in bleeding disorders or those on anticoagulants.
• Monitor for immune reconstitution inflammatory syndrome (IRIS) when used with effective ART.

⛔ Contraindications

• No absolute contraindications apart from known hypersensitivity to enfuvirtide or formulation components.

💥 Side Effects

• Injection-site reactions (pain, nodules, erythema) — occur in >90% of patients.
• Fatigue, headache, nausea, dizziness.
• Rare: pneumonia, peripheral neuropathy, or hypersensitivity reactions.

📚 References

• BNF: Enfuvirtide
• British HIV Association (BHIVA) Treatment Guidelines, 2023.
• European AIDS Clinical Society (EACS) Guidelines, 2023.