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Drug-Drug Interactions: Etravirine with Dolutegravir or Atazanavir

Publish Date: 
Friday, October 17, 2014

New data show that etravirine (ETR) substantially lowers plasma concentrations of dolutegravir (DTG) (DTG Cmin decreased 88%, AUC decreased 71%). This effect is lessened by coadministration of ritonavir-boosted PIs: the combination of ETR + DTG + darunavir/ritonavir (600/100 mg BID) resulted in a decrease in DTG Cmin and AUC of 37% and 25%, respectively. When ETR + DTG were given with lopinavir/ritonavir, the DTG Cmin and AUC were increased slightly. No data are available for the interaction with atazanavir/ritonavir.

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Elvitegravir Approved as an Independent Medication

Publish Date: 
Friday, September 26, 2014
Elvitegravir is an HIV integrase inhibitor that requires pharmacokinetic enhancement with cobicistat or ritonavir. Since 2012 it has been available in a coformulation with cobicistat, tenofovir, and emtricitabine (Stribild) for treatment-naïve adults. This month the FDA approved elvitegravir as an independent medication, for use in in combination with a ritonavir-boosted protease inhibitor (and other ARVs) in treatment-experienced adults. Its brand name is Vitekta.
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Cobicistat approved as PK booster

Publish Date: 
Friday, September 26, 2014
Cobicistat, a CYP3A inhibitor, has been approved by the FDA to be used as a pharmacokinetic booster for atazanavir and once-daily darunavir. Thus, it can be used as an alternative to ritonavir in these combinations. It already is available as a PK enhancer of elvitegravir in the elvitegravir/cobicistat/tenofovir/emtricitabine coformulation (Stribild). Cobicistat’s brand name is Tybost.
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New Fixed-Dose Combination Pill: Dolutegravir + Abacavir + Lamivudine

Publish Date: 
Friday, September 26, 2014
The FDA has approved the coformulation of the integrase inhibitor dolutegravir (50 mg) with the NRTIs abacavir (600 mg) and lamivudine (300 mg); its brand name is Triumeq. Triumeq is the first single-pill combination that does not include tenofovir.
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Project B.R.I.E.F – An Educational Video Intervention for HIV Prevention

Publish Date: 
Wednesday, September 10, 2014

Project B.R.I.E.F. (Behavior intervention, Rapid HIV test, Innovative video, Efficient cost and health care savings, and Facilitated seamless linkage to outpatient HIV care) began in 2003 as a collaboration between two physicians looking to make a difference in the Bronx, NY community. As attending physicians at Jacobi Medical Center, both Dr. Jason Leider and I experienced first-hand the impact of HIV on the Bronx, a community with one of the highest rates of HIV prevalence in the nation.

HIV Meds Updates: Fast Takes - ATV & Rilpivirine / Rifabutin

Publish Date: 
Friday, August 1, 2014

ATV pediatric powder formulation

An oral powder formulation of atazanavir has been approved by the FDA for use in infants and children older than 3 months and weighing 10 to <25 kg. It must administered with ritonavir, and used in combination with other antiretrovirals. For infants, it may be mixed with formula (or other liquid) and given with an oral syringe or cup. For older infants and young children, it may be mixed with yogurt or applesauce.

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Drug Interactions: Integrase Inhibitors and Cations

Publish Date: 
Friday, August 1, 2014

Antacids, laxatives, mineral supplements, and other compounds that contain metal cations (eg, calcium, magnesium, aluminum, and iron) may decrease levels of integrase inhibitors if taken close in time to each other. Results of two studies help to assess the magnitude of this effect and assist in determining how to manage it.

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Efavirenz Updates: Bone Mineral Density & Suicidality

Publish Date: 
Friday, August 1, 2014

Efavirenz and Bone Mineral Density

Persons with HIV infection have a number of risk factors for decreased bone mineral density (BMD), related not just to effects of HIV or resulting illness but also to ART. For example, BMD decreases by as much as 5-6% after initiation of ART, and certain ARVs (eg, tenofovir, protease inhibitors) cause greater losses over time than do others. It also is becoming clearer that vitamin D deficiency or insufficiency is common among HIV-infected persons, and that efavirenz can further lower levels of vitamin D.

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