Enfuvirtide binds to gp41 preventing the creation of an entry pore for the capsid of the virus, keeping it out of the cell.Enfuvirtide is also an activator of the chemotactic factor receptor, formyl peptide receptor 1, and thereby activates phagocytes and presumably other cells bearing this receptor (see formyl peptide receptors). The physiological significance of this activation is unknown. Microbiology
Enfuvirtide is considered to be active against HIV-1 only. Low activity against HIV-2 isolates has been demonstrated in vitro.Variable susceptibility to enfuvirtide has been observed in clinical isolates, with acquired resistance the result of a mutated 10 amino acid motif in viral gp41. Primary resistance, however, has yet to be observed. Clinical use
Indications
Enfuvirtide is indicated for the treatment of HIV-1 infection, in combination therapy with other antiretrovirals, in patients where all other treatments have failed. Dosage forms
By virtue of its peptide nature, enfuvirtide is marketed in injectable form. The lyophilised enfuvirtide powder must be reconstituted by the patient and administered twice daily by subcutaneous injection. Due to the chronic nature of this kind of therapy, this dosage form may be a major problem for the patients adherence to this drug regimen. Adverse effects
Common adverse drug reactions (≥1% of patients) associated with enfuvirtide therapy include: injection site reactions (pain, hardening of skin, erythema, nodules, cysts, itch; experienced by nearly all patients, particularly in the first week), peripheral neuropathy, insomnia, depression, cough, dyspnoea, anorexia, arthralgia, infections (including bacterial pneumonia) and/or eosinophilia.
A pelvic kidney, also known as an ectopic kidney, is a normal kidney located in the pelvis, instead of the abdomen. This occurs when a kidney does not ascend from its original location in the pelvis to its final location during prenatal development. They usually present no symptoms, but can increase risk of certain illnesses and healthcare problems. Signs and symptoms
Often, a person with a pelvic kidney will go through their whole life not even knowing they have a pelvic kidney. Complications
Typically, the kidney functions normally despite being in the wrong location. However, it can develop complications. A pelvic kidney can make it more difficult to diagnose kidney infections and kidney cancer. The renal artery and the renal vein may be stretched if they remain attached to the normal locations on the abdominal aorta and the inferior vena cava, which can lead to illness. Causes
In the development of the human embryo, the metanephric kidneys fail to ascend and usually remain at the brim of the pelvis. This clinical scenario may present no signs or symptoms and the kidneys may function normally. It is associated at times with Mullerian dysgenesis. Diagnosis
A pelvic kidney is discovered on newborn kidney ultrasound screening. It may also be detected if complications arise later in life for this or a completely different reason, and during investigations. Epidemiology
Between 1 in 2,200 and 1 in 3,000 people may have a pelvic kidney. History
A pelvic kidney is also known as an ectopic kidney. == References ==