Maraviroc, marketed as Celsentri (Europe) or Selzentry (US), is a CCR5 antagonist used in combination with other antiretroviral drugs to treat CCR5-tropic HIV-1 infection in adults and children. It blocks HIV entry into CD4 cells by binding to the CCR5 co-receptor, preventing viral fusion and infection without curing HIV or preventing transmission.
About maraviroc tablets
Maraviroc belongs to the class of entry inhibitors or CCR5 antagonists, distinct from other antiretrovirals that act after HIV enters cells. It selectively binds to human CCR5 receptors on immune cells, disrupting the interaction between HIV-1 gp120 and CCR5 needed for CCR5-tropic virus entry.
Treatment requires confirmation of CCR5-tropic HIV via tropism testing, as maraviroc is ineffective against CXCR4-tropic or dual/mixed-tropic strains. It is always used in combination antiretroviral therapy (ART) to suppress viral replication, increase CD4 counts, and reduce opportunistic infection risk.
Clinical trials like MOTIVATE-1 and MOTIVATE-2 demonstrated superior viral suppression: 45-56% achieved <50 copies/mL with maraviroc plus optimized background therapy (OBT) vs. 16-22% with placebo + OBT at 48 weeks. In treatment-naïve patients, it matched efavirenz efficacy when tropism was confirmed.
Before taking maraviroc tablets
Allergy
Avoid if allergic to maraviroc or any ingredients. Rare hypersensitivity reactions include rash, fever, and organ dysfunction; discontinue immediately if suspected.
Pregnancy and breastfeeding
Limited data; use only if benefits outweigh risks. No evidence of harm, but register in antiretroviral pregnancy registry. HIV transmission via breast milk possible; breastfeeding not recommended in high-resource settings.
Babies and children
Approved for ages 2+ weighing ≥10kg with CCR5-tropic HIV. Dosing based on weight and concomitant meds. Safety in <2 years unestablished.
Taking other medicines and herbal products
Maraviroc is metabolized by CYP3A; adjust dose with CYP3A inhibitors (e.g., ketoconazole: 150mg BID) or inducers (e.g., efavirenz: 600mg BID). Check interactions with protease inhibitors, NNRTIs.
| Drug Class | Examples | Dose Adjustment |
|---|---|---|
| Strong CYP3A Inhibitors | Lopinavir/ritonavir, darunavir/ritonavir | 150 mg BID |
| CYP3A Inducers | Efavirenz, etravirine | 600 mg BID |
| Nevirapine | – | 300 mg BID with low-dose ritonavir |
| No Adjustment | Tenofovir, zidovudine | 300 mg BID |
Conditions to look out for
- Heart/liver disease: Monitor liver enzymes; rare hepatotoxicity.
- Low blood pressure: May cause postural hypotension.
- High cholesterol: Monitor lipids.
- Immune reconstitution syndrome: Possible with starting ART.
How and when to take maraviroc tablets
Dosage
Adults: 300mg BID without CYP3A interactions; adjust per table above. Take with or without food.
Children (2-18 years, ≥10kg): Weight-based, e.g., 10-20kg: 50-75mg BID; max 300mg BID.
If you forget a dose
Take as soon as remembered unless near next dose; do not double. Adherence prevents resistance.
Swallowing difficulties
Tablets may be crushed and mixed with water/fruit juice for oral syringe administration; stable for 30 min.
If you take too much maraviroc
Overdose symptoms: postural hypotension, headache, dizziness. No specific antidote; supportive care, monitor vitals. Contact poison control.
Side-effects
Common (>1/10): cough, fever, rash, muscle pain.
| Frequency | Side Effects |
|---|---|
| Common (1-10%) | Rash, pyrexia, cough, dizziness, diarrhea, nausea, muscle/joint pain, hypertension |
| Uncommon | Hepatitis, anemia, neutropenia, anxiety, sleep disorders |
| Rare | Severe rash (DRESS), myocardial ischaemia, liver failure |
Lab abnormalities: elevated liver enzymes, low lymphocytes, high eosinophils. CD4 increases greater with maraviroc vs. placebo. Report rash/fever promptly.
Resistance to maraviroc
HIV mutates, developing resistance via CCR5 mutations or tropism shift to CXCR4. Combining with ≥2 active drugs delays resistance. Tropism shifts cause faster failure (30 days earlier).
Tropism testing
Mandatory pre-treatment; re-test if virologic failure. Genotypic assays recommended.
Stopping or switching treatment
Do not stop without doctor advice; viral rebound risks resistance. Switch if tropism change or intolerance.
Expiry dates
Check packaging; discard expired. Store below 30°C.
Further information
- Does not prevent HIV transmission; use condoms/PrEP.
- Regular monitoring: viral load, CD4, tropism, labs.
- Adherence critical for efficacy.
Frequently Asked Questions
What is maraviroc used for?
Treats CCR5-tropic HIV-1 in combination ART; suppresses virus, boosts immunity.
Does maraviroc cure HIV?
No, manages but does not cure or prevent transmission.
Who should not take maraviroc?
Those with CXCR4/dual-tropic HIV or hypersensitivity.
Common side effects?
Rash, cough, fever, muscle pain; monitor liver function.
How to take with other HIV drugs?
Dose adjusts based on interactions; always test tropism first.
References
- Maraviroc (Celsentri) — CATIE. 2023. https://www.catie.ca/maraviroc-celsentri
- Maraviroc (Celsentri®) Tablets: 150 and 300 mg — HIV Medication Guide. 2019-06. https://www.hivmedicationguide.com/wp-content/uploads/2019/06/maraviroc_long.pdf
- Maraviroc: Uses, Interactions, Mechanism of Action — DrugBank. 2024. https://go.drugbank.com/drugs/DB04835
- Maraviroc (Celsentri) — aidsmap. 2021. https://www.aidsmap.com/about-hiv/arv-background-information/maraviroc-celsentri
- Maraviroc in the treatment of HIV infection — PMC/NIH. 2009-10-12. https://pmc.ncbi.nlm.nih.gov/articles/PMC2761192/
- CELSENTRI Consumer Medicine Information — ViiV Healthcare. 2023. https://viivhealthcare.com/content/dam/cf-viiv/viivhealthcare/en_AU/files/celsentri-cmi-au.pdf
- Maraviroc (oral route) — Mayo Clinic. 2024. https://www.mayoclinic.org/drugs-supplements/maraviroc-oral-route/description/drg-20071288
