The hearts normal right atrium occurs on the left, and the left atrium is on the right. The lung anatomy is reversed and the left lung has three lobes while the right lung has two lobes. The intestines and other internal structures are also reversed from the normal, and the blood vessels, nerves, and lymphatics are also transposed. If the heart is swapped to the right side of the thorax, it is known as "situs inversus with dextrocardia" or "situs inversus totalis". If the heart remains on the normal left side of the thorax, a much rarer condition (1 in 2,000,000 of the general population), it is known as "situs inversus with levocardia" or "situs inversus incompletus". Situs inversus of the optic disc may occur unilaterally or bilaterally, associated with reduced binocularity and stereoacuity resembling monofixation syndrome. It is characterized by emergence of the retinal vessels in an anomalous direction (from the nasal rather than the temporal aspect) with dysversion (tilt) of the optic disc.Situs inversus does not appear to significantly affect rates of handedness. Based on a 2004 study documenting situs inversus in individuals with primary ciliary dyskinesia, the proportion of right-handedness among those with situs inversus did not differ significantly from that of those with situs solitus. Diagnosis
Diagnosis of situs inversus can be made using imaging techniques such as x-ray, ultrasound, CT scan, and magnetic resonance imaging (MRI).Any potential treatment for situs inversus would involve a complete and highly invasive surgical rearrangement of the internal viscera of the patient.
Breastfeeding
The US Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers do not breastfeed their infants to avoid risking postnatal transmission of HIV. This recommendation is coupled with the potential for serious adverse reactions in nursing infants. Dolutegravir and abacavir were shown to be excreted in the milk of lactating rats. Lamivudine was shown to be excreted in human breast milk. History
Approval
The patent was filed on April 28, 2006, and expires on October 5, 2027. It was approved for use in the United States and in the European Union in 2014. Major label changes
In August 2015, the Food and Drug Administration (FDA) sent a bulletin regarding label updates for dolutegravir and Triumeq regarding drug-drug information.Drug interactions was updated to include a statement that in vitro, dolutegravir was not a substrate of OATP1B1 or OATP1B3.