₦airaland Forum

she should have pull completely in stead of half nude rubbish

FOOLS WILL SAY GOOD DEVELOPMENT INTERESTS RATE IN EUROPE IS .5% BLIND FOOL'S

falana is a disgrace to this country

R I P. it happen on my street

Petition to the President and Commander in Chief, Federal Republic of Nigeria on the Proposed Establishment of Cattle Colony in Kogi State
The President and Commander in Chief, Federal Republic of Nigeria Cc: The President of the Senate, Federal Republic of Nigeria Speaker of the Federal House of Representatives The Honourable Minister of Agriculture The Governor of Kogi state Kogi-East Representatives at the National Assembly The Chairman, Igala Area Traditional Council
WE REJECT CATTLE COLONY IN IGALA LAND Following the recent declaration by your Agriculture Minister, Chief Audu Ogbeh on the establishment of ‘cattle colonies’ across Nigeria, as the only solution to the protracted clash between Fulani herdsmen and farmers; and the request from the Kogi State Governor Alh Yahaya Bello to have Kogi designated as the pioneer state to host a cattle colony, we the Igala people of Kogi-East cutting across nine LGAs namely Ankpa, Bassa, Dekina, Ibaji, Idah, Igalamela/ Odolu, Ofu, Olamaboro and Omala LGAs write to dissociate ourselves and our area from the purported plan to situate any cattle colony in our land. We wish to state that our vehement opposition to this move is predicated on the fact that it will eventually lead to breakdown of law and order with killings and wanton destruction of property, as our people, who are largely farmers, are not prepared to host Fulani herdsmen or cattle colony masters in our land. Our position is further reinforced by the multiple acts of war and mayhem being unleashed daily, on our innocent farmers and hapless law-abiding citizens, in their villages, homes and farm lands, by rampaging Fulani herdsmen. Mr. President, between June 2015 and December 2017, Igala land has witnessed several incidences of killings as a result of herdsmen violence in several areas including Ebeje where 8 people were killed and farms set ablaze, Agbada/Agojeju where 19 people were slaughtered, Edede – 2 persons were killed, 6 people killed in Oganenigu, 3 people killed in Ojapata, 5 people killed in Ojuwo Anawo. All these happened in Dekina Local Government Area. The story is not different in Ofu local government area at Ojuwo Omachi and Akpagidigbo where the incessant attacks of herdsmen have claimed the lives of over 20 persons. In Abejukolo and Bagana in Omala Local Government Area, the reign of terror resonates loudly, so much that our people no longer move freely, to and from their farm lands, because of the fear of killings, maiming and rape, with some villages like Ebakume wholly sacked and entire farm produce granaries/silos completely burnt. Despite the brazen nature of the aforementioned acts of criminality by these would-be occupants of the so-called cattle colony, none of them has been arrested or made to account for these crimes, as these heavily armed cattle herders terrorise our land, flaunting their prowess in the handling of AK 47 rifles and double barrel guns. Dear Mr President, our opposition to this move and the hasty approval given by the Kogi State Governor is further reinforced by the inescapable fact that under your Presidency, murderous Fulani herdsmen have enjoyed subtle protection and favouritism to the extent that these herdsmen, who now treat Nigeria as a conquered territory, will eventually go beyond the purview of the so- called colony to destroy farmlands, maim and kill under the slightest provocation. In view of the above and many more, we the undersigned concerned people of Kogi-East, Kogi State, North-Central, Nigeria state as follows: We do not want cattle colony or grazing reserve in our land We reject any attempt to convert or transfer the ownership of ancestral lands in Igala land to cattle colony master or owners who operate by killing people, destroying communities wholesale, and destroying farmlands while enjoying government protection from counter attack, arrest or prosecution. We reject attempts to turn Igala land into the next killing field of marauding Fulani herdsmen

Project IGALA

true talk

BETTER FOR THEM

hmmmmm

Num 18:24 Instead, I give to the Levites as their inheritance the tithes that the Israelites present as an offering to the LORD. That is why I said concerning them: 'They will have no inheritance among the Israelites.'" Num 18:26 "Speak to the Levites and say to them: 'When you receive from the Israelites the tithe I give you as your inheritance, you must present a tenth of that tithe as the LORD'S offering. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:31 You and your households may eat the rest of it anywhere, for it is your wages for your work at the Tent of Meeting. Deu 14:22 Be sure to set aside a tenth of all that your fields produce each year. Deu 14:23 Eat the tithe of your grain, new wine and oil, and the firstborn of your herds and flocks in the presence of the LORD your God at the place he will choose as a dwelling for his Name, so that you may learn to revere the LORD your God always. Deu 14:24 But if that place is too distant and you have been blessed by the LORD your God and cannot carry your tithe (because the place where the LORD will choose to put his Name is so far away), Deu 14:25 then exchange your tithe for silver, and take the silver with you and go to the place the LORD your God will choose. Deu 14:26 Use the silver to buy whatever you like: cattle, sheep, wine or other fermented drink, or anything you wish. Then you and your household shall eat there in the presence of the LORD your God and rejoice. Deu 14:27 And do not neglect the Levites living in your towns, for they have no allotment or inheritance of their own. Deu 14:28 At the end of every three years, bring all the tithes of that year's produce and store it in your towns, Deu 14:29 so that the Levites (who have no allotment or inheritance of their own) and the aliens, the fatherless and the widows who live in your towns may come and eat and be satisfied, and so that the LORD your God may bless you in all the work of your hands. Deu 26:12 When you have finished setting aside a tenth of all your produce in the third year, the year of the tithe, you shall give it to the Levite, the alien, the fatherless and the widow, so that they may eat in your towns and be satisfied. Deu 26:13 Then say to the LORD your God: "I have removed from my house the sacred portion and have given it to the Levite, the alien, the fatherless and the widow, according to all you commanded. I have not turned aside from your commands nor have I forgotten any of them. Deu 26:14 I have not eaten any of the sacred portion while I was in mourning, nor have I removed any of it while I was unclean, nor have I offered any of it to the dead. I have obeyed the LORD my God; I have done everything you commanded me. 1st timothy 1 vs 8. the law is good if it is used correctly

Num 18:24 Instead, I give to the Levites as their inheritance the tithes that the Israelites present as an offering to the LORD. That is why I said concerning them: 'They will have no inheritance among the Israelites.'" Num 18:26 "Speak to the Levites and say to them: 'When you receive from the Israelites the tithe I give you as your inheritance, you must present a tenth of that tithe as the LORD'S offering. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:31 You and your households may eat the rest of it anywhere, for it is your wages for your work at the Tent of Meeting. Deu 14:22 Be sure to set aside a tenth of all that your fields produce each year. Deu 14:23 Eat the tithe of your grain, new wine and oil, and the firstborn of your herds and flocks in the presence of the LORD your God at the place he will choose as a dwelling for his Name, so that you may learn to revere the LORD your God always. Deu 14:24 But if that place is too distant and you have been blessed by the LORD your God and cannot carry your tithe (because the place where the LORD will choose to put his Name is so far away), Deu 14:25 then exchange your tithe for silver, and take the silver with you and go to the place the LORD your God will choose. Deu 14:26 Use the silver to buy whatever you like: cattle, sheep, wine or other fermented drink, or anything you wish. Then you and your household shall eat there in the presence of the LORD your God and rejoice. Deu 14:27 And do not neglect the Levites living in your towns, for they have no allotment or inheritance of their own. Deu 14:28 At the end of every three years, bring all the tithes of that year's produce and store it in your towns, Deu 14:29 so that the Levites (who have no allotment or inheritance of their own) and the aliens, the fatherless and the widows who live in your towns may come and eat and be satisfied, and so that the LORD your God may bless you in all the work of your hands. Deu 26:12 When you have finished setting aside a tenth of all your produce in the third year, the year of the tithe, you shall give it to the Levite, the alien, the fatherless and the widow, so that they may eat in your towns and be satisfied. Deu 26:13 Then say to the LORD your God: "I have removed from my house the sacred portion and have given it to the Levite, the alien, the fatherless and the widow, according to all you commanded. I have not turned aside from your commands nor have I forgotten any of them. Deu 26:14 I have not eaten any of the sacred portion while I was in mourning, nor have I removed any of it while I was unclean, nor have I offered any of it to the dead. I have obeyed the LORD my God; I have done everything you commanded me. 1st timothy 1 vs 8. the law is good if it is used correctly

Num 18:24 Instead, I give to the Levites as their inheritance the tithes that the Israelites present as an offering to the LORD. That is why I said concerning them: 'They will have no inheritance among the Israelites.'" Num 18:26 "Speak to the Levites and say to them: 'When you receive from the Israelites the tithe I give you as your inheritance, you must present a tenth of that tithe as the LORD'S offering. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest. Num 18:31 You and your households may eat the rest of it anywhere, for it is your wages for your work at the Tent of Meeting. Deu 14:22 Be sure to set aside a tenth of all that your fields produce each year. Deu 14:23 Eat the tithe of your grain, new wine and oil, and the firstborn of your herds and flocks in the presence of the LORD your God at the place he will choose as a dwelling for his Name, so that you may learn to revere the LORD your God always. Deu 14:24 But if that place is too distant and you have been blessed by the LORD your God and cannot carry your tithe (because the place where the LORD will choose to put his Name is so far away), Deu 14:25 then exchange your tithe for silver, and take the silver with you and go to the place the LORD your God will choose. Deu 14:26 Use the silver to buy whatever you like: cattle, sheep, wine or other fermented drink, or anything you wish. Then you and your household shall eat there in the presence of the LORD your God and rejoice. Deu 14:27 And do not neglect the Levites living in your towns, for they have no allotment or inheritance of their own. Deu 14:28 At the end of every three years, bring all the tithes of that year's produce and store it in your towns, Deu 14:29 so that the Levites (who have no allotment or inheritance of their own) and the aliens, the fatherless and the widows who live in your towns may come and eat and be satisfied, and so that the LORD your God may bless you in all the work of your hands. Deu 26:12 When you have finished setting aside a tenth of all your produce in the third year, the year of the tithe, you shall give it to the Levite, the alien, the fatherless and the widow, so that they may eat in your towns and be satisfied. Deu 26:13 Then say to the LORD your God: "I have removed from my house the sacred portion and have given it to the Levite, the alien, the fatherless and the widow, according to all you commanded. I have not turned aside from your commands nor have I forgotten any of them. Deu 26:14 I have not eaten any of the sacred portion while I was in mourning, nor have I removed any of it while I was unclean, nor have I offered any of it to the dead. I have obeyed the LORD my God; I have done everything you commanded me. 1st timothy 1 vs 8. the law is good if it is used correctly

. Num 18:22 From now on the Israelites must not go near the Tent of Meeting, or they will bear the consequences of their sin and will die.

Num 18:24 Instead, I give to the Levites as their inheritance the tithes that the Israelites present as an offering to the LORD. That is why I said concerning them: 'They will have no inheritance among the Israelites.'"

Num 18:26 "Speak to the Levites and say to them: 'When you receive from the Israelites the tithe I give you as your inheritance, you must present a tenth of that tithe as the LORD'S offering.

Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest.

Num 18:28 In this way you also will present an offering to the LORD from all the tithes you receive from the Israelites. From these tithes you must give the LORD'S portion to Aaron the priest.

Num 18:31 You and your households may eat the rest of it anywhere, for it is your wages for your work at the Tent of Meeting.

Deu 14:22 Be sure to set aside a tenth of all that your fields produce each year.

Deu 14:23 Eat the tithe of your grain, new wine and oil, and the firstborn of your herds and flocks in the presence of the LORD your God at the place he will choose as a dwelling for his Name, so that you may learn to revere the LORD your God always.

Deu 14:24 But if that place is too distant and you have been blessed by the LORD your God and cannot carry your tithe (because the place where the LORD will choose to put his Name is so far away),

Deu 14:25 then exchange your tithe for silver, and take the silver with you and go to the place the LORD your God will choose.

Deu 14:26 Use the silver to buy whatever you like: cattle, sheep, wine or other fermented drink, or anything you wish. Then you and your household shall eat there in the presence of the LORD your God and rejoice.

Deu 14:27 And do not neglect the Levites living in your towns, for they have no allotment or inheritance of their own.

Deu 14:28 At the end of every three years, bring all the tithes of that year's produce and store it in your towns,

Deu 14:29 so that the Levites (who have no allotment or inheritance of their own) and the aliens, the fatherless and the widows who live in your towns may come and eat and be satisfied, and so that the LORD your God may bless you in all the work of your hands.

Deu 26:12 When you have finished setting aside a tenth of all your produce in the third year, the year of the tithe, you shall give it to the Levite, the alien, the fatherless and the widow, so that they may eat in your towns and be satisfied.

Deu 26:13 Then say to the LORD your God: "I have removed from my house the sacred portion and have given it to the Levite, the alien, the fatherless and the widow, according to all you commanded. I have not turned aside from your commands nor have I forgotten any of them.

Deu 26:14 I have not eaten any of the sacred portion while I was in mourning, nor have I removed any of it while I was unclean, nor have I offered any of it to the dead. I have obeyed the LORD my God; I have done everything you commanded me.

1st timothy 1 vs 8. the law is good if it is used correctly

great trend

The community of ladies who are tired of the “come to my
house syndrome” Are u all virgins ? I asked because you are asking for respect due to virgin girls only, 99% of girls are prostitute who date old men for money, nonsense

Since we all know that Akingbola and Ibru were looting the
public silly through their banks and donating part of it to
the church, I personally think the church should refund this
money back to the govt. Any key donations the duo made should be returned to the
public Since the 2 were key donors for the jet, and other key
financial dealings of the church. This brings me to the story of a man who was alleged to
have sold a generator at Sheraton Hotels and gave 10% to
Christ Embassy, what became of the money?

A LARGE NO OF CHRISTIANS ARE FOOLISH AND STUPID, THEY THING BY CAN BRIBE GOD WITH MONEY AND BY DEFENDING THEIR STUPID PROTESTANT DAD AND MUM G O THEIR WILL MAKE HEAVEN, NONSENSE, FOOLISH PASTORS FOOLISH FELLOWER


Deuteronomy 23:18 18 Thou shalt not bring the hire of a LovePeddler, or the price of a dog, into the house of the Lord thy God for any
vow: for even both these[ are] abomination unto the LORD
thy God. I agree with you. But A pastor has no way of determining the
source of an offering or donation. Jesus did not ask where
Mary Madgalene God the money for the perfume she poured
on him. Even though tradition says she was a LovePeddler

the bill appears to stipulate those incidents will not be considered crimes if the victims are older than 11; with Mr. Falana saying those age limits were inserted wrongly into the original bill. “But since the obnoxious provision was illegally inserted by the Committee on Judiciary and Legal Matters without approval, the Senate ought to reverse itself and amend the relevant provisions of the Sexual Offences Bill, 2015. Our Law firm has made a request to that effect. “Finally, if the Bill is eventually passed into law with its obnoxious provisions we shall not hesitate to pray the Federal High Court to strike it down in view of Article 18(3) of the African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act (Cap A9) Laws of the Federation of Nigeria, 2004 which has imposed a duty on the Government of Nigeria to ensure the elimination of every discrimination against women and ensure the protection of the rights of the woman and the
child, as stipulated in international declarations and conventions.” Mr. Soyinka had, on Friday, urged President Muhammadu Buhari to withhold his assent to the bill (which is also known as the anti-rape bill) passed by the last National Assembly. According to Mr. Soyinka, a nation should not be founded on the sexual exploitation of the fragile and innocent. “President Buhari – and here I make my first imposition on his presidency – should never place his assent on such a nefarious distraction,” Mr. Soyinka had said. “Its implications doom the victim to afflictions that churn the stomach even to think of the human toll. Perhaps those legislators think that vaginal fistula is something thought up by arm-chair critics with nothing better to occupy their minds. No matter, let those who profess a genuine concern declare their stand on this.” The Sexual Offences Bill, 2015, was among the 46 bills passed
by the 7th Senate in a last minute flurry of activities last week. In his letter, Mr. Falana said that the Bill had not been forwarded to the president for his assent as it had not been passed by the House of Representatives. “However, it would be recalled that Senator Chris Anyanwu who sponsored the Sexual Offences Bill had justified the urgent need to pass it to save our girls and women from sexual exploitation and molestation,” said Mr. Falana. “When the Bill was unanimously passed for a second reading by the Senate on November 21, 2013, it sought to prescribe a
penalty of life imprisonment for the offence of defilement of children less than 18 years of age. “It also provided for compulsory documentation, supervision of sexual offenders and medical treatment for rape victims while it strengthened the weak protection offered victims and witnesses in trials for sexual offences.” The minimum age of 18 years stated in the original Bill was in line with the provisions of the Child’s Rights Act, 2003, according to Mr. Soyinka, and the Child’s Rights Convention of the United Nations which had been ratified by Nigeria. The Bill was referred to the Senate Committee on Judiciary and Legal Matters for further legislative work. It was that Committee that illegally removed the age of 18 years and replaced it with 11 years, said Mr. Falana. “The inserted clause is inconsistent with Section 29(4)(a) of the Nigerian Constitution which provides that ‘full age’ means the age of 18 years and above.”

R I P

[b][/b]THE DEVIL COMES NOT BUT TO STEAL TO KILL AND TO DESTROY, GOD FORBID THAT I SHOULD BE PART OF SANTANIC RELIGION. THE TRUTH IS CLEAR IN THIS MATTER, FATHER WE SENT CONFUSSION INTO THE CAMP OF THE ENEMY IN JESUS NAME, THERE SHALL NEVER EXPERIENCE PEACE IN LINE WITH GOD WORD. NO PEACE FOR THE WICKED. PROPTHET OF SWORD

airtel has a package call 2good migration code is *446# 12 kobo per second to all network no access fee

Sahara Reporters "We've Just Rescued Over 200 Girls In A Daring Attack On Boko
Haram Hideout In Sambisa"- Nigerian Army While confirming the operation the Director Defence
Information, Major General Chris Olukolade said he could not
confirm the identity of the freed victims and their origins
and he could not state if any of them was from Chibok until
after thorough screening and proper investigations. READ MORE... http:///1zalLSh

Muhammad the prophet of doom

congratulation

[b][/b] the op is a foolish man, i have never come across a stupid man like the op, you are a dead man already, i gues u originate from a family of fools

[b][/b]plain truth

[b][/b] am too inteligent to be a muslim muhammed does not have what it take to convince me religion for d fools

[i][/i] hmmmmm na wa

[i][/i] the bible said we should have regard for life, smoking endanger ur life, if u smoke u have no regard for life and that make it a sin

1. Entry inhibitors:
a. Enfuvirtide (FuzeonT20)
b. Maraviroc (Selzentry –
FDA approved CCR5 co-
receptor antagonist for
treatment-experienced HIV adults with only CCR5-tropic
HIV-1 strains resistant to
multiple antiretroviral
agents. 2. Protease inhibitors:
darunavir and tipranavir 3. Integrase inhibitors:
raltegravir (Isentress)
approved by FDA for HIV
treatment-experienced
adult with HIV strains
resistant to multiple antiretroviral agents. There are three antiretroviral agents in development. 1. Entry inhibitors including
TNX-355 and vicriviroc 2.
Integrase inhibitors,
including elvitegravir, and
3. A novel agent belonging
to the maturation inhibitor class, bevirimat. The two classes of target for antiretroviral
therapy that will be discussed here are the entry
inhibitor maraviroc and the integrase inhibitor
raltegravir. The use of tropism assays including
Trofile and SensiTrop will be discussed to help
clinicians make decisions of when to use the CCXR5 inhibitor in treatment-experienced
patients. Mechanism of Entry Mechanisms of HIV entry involve attachment,
triggering and fusion. Entry of the virus into the CD4+ cell involves binding of the viral gp120 envelope protein to the CD4 receptor on the host
cell, followed by interactions with chemokine
receptors, either CCR5 or CXCR4, which leads to
fusion of the viral and cell membranes. (See “HIV
Inhibition” figure, below.) HIV INHIBITION GRAPHIC Graphic Source: Clinical Care Options
downloadable slideset: Understanding HIV
Entry and Targets for Therapy;October 2007.
Available at: www.clinicaloptions.com/tropism.
®Clinical Care Options 2007; reproduced with
permission. HIV tropism HIV tropism is the ability of a given
HIV strain to use CCR5 and/or CXCR4 as co- receptors for entering CD4+ cells.4 When protein on the virus binds to CCR5 or CXCR4,
conformational changes occur that enable it to
cause membrane fusion. Drugs that prevent
these steps are referred to as entry inhibitors.
The virus that enters the cell using the CCR5 co-
receptor is termed R5 virus. Viruses that use CXCR4 co-receptor are termed X4 viruses. Viruses
that can use either co-receptor are termed R5/X4 or dual tropic viruses.4 New HIV infections are almost always due to R5 viruses. The CCR5
antagonists have activity against R5 tropic virus
only, and cannot be used for patients who have
dual-mixed tropic (D/M) or X4 virus. In some
patients, D/M and/or X4 viruses emerge years
after infection. Most of the experience in clinical trials for assessing co-receptor tropism has been
with one commercially developed assay, the Trofile.5 1) HIV RNA suppression – Phase IIb/III studies of maraviroc in treatment experienced
patients and treatment-naïve patients with R5
virus have been presented. In MOTIVATE trials,
triple class-resistant patients were
randomized to maraviroc 150mg or 300mg
daily or BID or to placebo, both combined with an optimized background regimen (OBR).
At 24 weeks, twice the proportion of patients
on maraviroc plus OBR vs. placebo plus OBR
achieved the primary endpoint of HIV-1 RNA <400 copies/ml.6, 7 Use of maraviroc is not recommended in patients with D/M or X4
HIV-1, as efficacy was not demonstrated in a
Phase II study, nor is its safety and efficacy
established in treatment-naïve adult patients or pediatric patients.8 2) Tropism Shifting or Switching – In an HIV- positive patient, viral tropism is not fixed at
primary infection, but may evolve towards
CXCR4 use over time. In some patients only a
small amount of CXCR4 may be present,
possibly existing below the limits of detection
by current technologies. This drug associated shift or switch in the population tropism will
result in a change in the tropism call, e.g.,
from R5 to dual/mixed or X4 tropism. It has
not yet been determined whether such a
coreceptor antagonist associated switch/shift
has an impact on disease progression over long-term follow-up. 3) Unmasking caused by co-receptor
antagonist exposure – treatment with a co- receptor antagonist will suppress the majority
R5 population revealing the underlying CXCR4
virus. 4) Resistance – the virus may develop phenotypic resistance to the CCR5 coreceptor antagonist, and this area is being explored.9 Several studies have used this assay to define the
prevalence of co-receptor usage in various
patient populations. Data from 8 cohorts, 3 of
them treatment naïve-patients, and 5 of the
treatment-experienced patients revealed that
dual/mixed or X4 virus appears to be less prevalent among those with earlier stages of disease.6, 10-14 Even among treatment-naïve subjects, 12-19% of individuals had detectable D/ M or X4 virus.10,12 Therefore, it is necessary to assess each individual patient for viral tropism
before the use of a CCR5 antagonist cells to alter
the conformational state of the receptor.
Monogram’s co-receptor assay, Trofile, identifies
the tropism of a patient’s virus. The sensitivity to
detect minority variant populations is 100% when X4 virus is 10% and is 85% when X4 virus is
5% with successful amplification and reliable results with viral load >1000 copies/ml.8 Another challenge for the use of maraviroc will be
reimbursement for the cost of the tropism assay.
The FDA has approved Pathway Diagnostics for
the process of SensiTrop HIV Co-receptor Tropism
Assay, a secondgeneration molecular based
diagnostic HIV tropism assay, with a projected turn around time as fast as 2-4 days compared to
the cell based assay development time of two
weeks or more. Pathway describes this assay as
highly sensitive in detecting CXCR4-tropic HIV in
patient samples that contain as little as 1% CXCR4.10
Entry Inhibitors Maraviroc is an antiviral CCR5 co-receptor
antagonist indicated for treatment-
experienced adults infected with only CCR5-
tropic HIV-1 who have evidence of viral
replication and HIV-1 strains resistant to
multiple antiretroviral agents. Use of this drug is not recommended in patients with dual/
mixed or CXCR4 tropic HIV-1 as efficacy was not
demonstrated in a Phase 2 study of this patient
group and safety and efficacy have not been
established in treatmentnaïve adult or
pediatric patients. The recommended dose differs based on concomitant medications
used. Dosing may be 150mg BID, 300mg BID or
600mg BID. Maraviroc comes with a black box
warning of hepatoxicity with allergic features.
In such cases, discontinuation of the
medication should be considered with signs and symptoms of hepatitis, or with increased
liver transaminases combined with a rash. The drug should be used with caution in
patients with increased cardiovascular risk,as
myocardial ischemia and/or infarction were
observed in patients. Immune reconstitution
syndrome has been reported in patients
treated with a combination antiretroviral therapy as well as increased risk of developing
upper respiratory infections and herpes virus
infections.There was no potential risk of
malignancy due to maraviroc, but long-term
follow-up is needed to assess this risk. The
most common adverse events with twice daily therapy included cough, pyrexia, upper
respiratory tract infections, rash,
musculoskeletal symptoms, abdominal pains,
and dizziness. Some of the less common side
effects included Clostridium difficile colitis.
Maraviroc is a substrate for cytochrome P4503A4 and so several antiretroviral agents
have been shown to have relevant drug-drug interactions with it as shown below.15 Maraviroc Dosage Adjustments with Co- Administered CYP3A Inhibitors or Inducers Reduce dose when given with
strong CYP3A inhibitors (with or
without CYP3A inducers)
including PI (except tipranavir/
ritonavir), delavirdine,
ketoconazole, itraconazole, clarithromycin, telithromycin 150 mg twice daily Use standard dose when given
with NRTI, tipranavir/ritonavir,
nevirapine, enfuvirtide and other
drugs that are not strong CYP3A
inhibitors or CYP3A inducers 300 mg twice daily Increase dose when given with
CYP3A inducers (without a strong
CYP3A inhibitor) including
efavirenz, rifampin,
carbamazepine, phenobarbital,
phenytoin 600 mg twice daily Administration of maraviroc with St. John’s
Wort is not recommended as it will decrease
maraviroc concentrations and lead to loss of
virologic response and possible resistance.
Maraviroc should be used with caution in
patients with renal impairment and in patients with pre-existing liver dysfunction, or who are
co-infected with hepatitis B or C. It can be
taken with or without food. Integrase Inhibitors Integrase enzyme is required for HIV-1
replication. It catalyzes the irreversible process
of integrating the viral DNA into the host cell’s
DNA, called integration. The viral integrase
enzyme is a target for antiviral therapy by
integrase inhibitors. Raltegravir (formerly MK-0518) was recently approved by the FDA for
the treatment of HIV-1 infection in treatment-
experienced adult patients who have HIV-1
strains that are resistant to multiple
antiretroviral agents. The safety and efficacy of
raltegravir have not been established in treatmentnaïve adult patients or pediatric
patients. The dosage is 400mg twice daily with or without food.16 Caution should be used during the initial phase
of treatment, when patients may develop
immune reconstitution syndrome. The most
common side effects reported are diarrhea,
nausea, headache, and pyrexia. Cancers like
Kaposi’s sarcoma, lymphoma, squamous cell carcinoma, hepatocellur carcinoma, and anal
cancer were reported in treatment experienced
subjects, but it is unknown if these cancers
were related to raltegravir use. The rates of AST
and ALT abnormalities were higher in the
subjects co-infected with hepatitis B and/or hepatitis C. It is metabolized by UGT1A1
glucuronidation pathway, and hence, caution
should be used with rifampin or other strong
inducers of UGT1A1. Less strong inducers like
efavirenz, nevirapine, rifabutin, and St. John’s Wort may be used with raltegravir.15 The mutations that resulted in raltegravir
resistance included an amino acid substitution
at either Q148 (changed to H, K, or R) or N155
(changed to H) plus one or more substitutions
(L74M/R, E92Q,T97A, e138A/K, G140A/S, V151I,
G163R, H183P, Y226D/F/H, S230R and D232N). Another pathway to raltegravir resistance was
seen with amino acid substitution at Y143C/H/ R.15 BENCHMRK 1 and 2 studies confirmed the
potency of raltegravir in treatment- experienced patients.16,17 Patients were randomized to raltegravir 400mg twice daily,
or to placebo plus an OBR. At 16 weeks, 77% of
patients in the raltegravir arms had HIV-1 RNA
<400 copies/ml compared to 41-43% of placebo patients. CD4+ cell count response was also significantly higher in the raltegravir arms
(83-86 cells/mm3) than in control as (31-40
cells/mm3). Data from BENCHMRK studies
indicate that this drug will be beneficial in
treatment-experienced patients when
combined with at least one other active agent. Raltegravir does not require ritonavir boosting.
Twice daily dosing will be a drawback, but the
drug’s tolerability and lack of toxicity in studies
will expand the options for sequential
antiretroviral regimens. CONCLUSION As with any antiretroviral agent, the patient
should be informed that neither maraviroc nor
raltegravir is a cure for HIV infection, and that
he or she can still develop opportunistic
infections. These treatments do not lower the
risk of passing HIV to other people through sexual contact or sharing needles, so they
should continue to practice safer sex, and use
barrier methods to lower the chance of sexual
contact with any body fluids. Patients should
remain under the care of a physician when
using these drugs, and if they forget to take a dose, they should take the next dose of
medication as soon as possible and then take their next scheduled dose at its regular time.

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