UCSF Center for HIV Information

University of California, San Francisco
1700 Owens Street, Suite 316
San Francisco, CA 94158

phone: (415) 575-0517

UCSF CHI Online

Resources: 2

Articles: 59

  • CROI 2017: Dolutegravir in 2-Drug Simplification Studies

    In recent years, a number of studies have evaluated 2-drug or even 1-drug ARV regimens, either in initial therapy or in switch regimens for patients with virologic suppression on 3-drug therapy. In general, these have not been as successful in achieving or maintaining virologic suppression as...

  • CROI 2017: Failure of Dolutegravir Monotherapy

    Leading up to this year, some researchers and clinicians had optimistically viewed dolutegravir an invincible ARV, a drug so mighty that it was unlikely to fail, and even more unlikely to be victim to emergent resistance mutations. Two presentations at CROI demonstrated the...

  • CROI 2017: Doravirine Noninferior to Darunavir + Ritonavir in Initial Treatment

    Doravirine is an investigational NNRTI that is active in vitro against many common NNRTI resistance mutations (including K103N, Y181C, and E138K). It is given once daily, has no food restrictions, and can be given with acid-blocking medications. In a Phase 2 study of treatment-...

  • CROI 2017: Bictegravir and Dolutegravir, Head-to-Head Comparison

     

    Bictegravir is an investigational integrase inhibitor that is dosed once daily, unboosted. It is active in vitro against many viruses with integrase resistance mutations. A Phase 2 double-blind placebo-controlled study randomized treatment-naive patients (n...

  • HIV Meds Update: ART in Acute HIV--Decreasing HIV DNA

    We know that very early treatment in acute HIV infection decreases HIV RNA; this study shows it also greatly decreases proviral DNA (and reservoir size). Researchers investigated 2 small cohorts of patients in Thailand with acute (and very early) HIV infection, 1 untreated and 1 treated with ART...

  • HIV Meds Update: Improvements in ART and Viral Suppression Rates in the United States

    Using data from the Medical Monitoring Project, this article presents a useful view of ARV treatment in the United States. The analysis demonstrates that U.S. national rates of both ARV prescribing (for persons maintained in care) and viral suppression to <200 copies/mL increased from...

  • HIV Meds Update: PrEP Uptake by Sex, Race, and Age

    At the ASM Microbe meeting in June, researchers from Gilead Sciences presented data on use of TDF/FTC (Truvada) PrEP in the United States according to sex and race. They evaluated national pharmacy databases to identify prescriptions of TDF/FTC given for PrEP between January 2012 and September...

  • HIV Meds Update - RAPID: Immediate ART Initiation

    This publication presents the results of San Francisco General Hospital's Ward 86 pilot study of immediate ART initiation. This RAPID program systematically offered ART to patients upon diagnosis of HIV; patients were referred from HIV testing sites in San Francisco. Of the 39 patients who...

  • HIV Meds Update: Treatment as Prevention: Suppressive ART, Condomless Sex, and HIV Transmission Risk; also a Word on HPTN 052

    The PARTNER Study, a multisite European study, evaluated rates of HIV transmissions within serodifferent heterosexual and MSM couples (n = 548 and n = 340, respectively, contributed eligible data). The HIV-positive partners were on ART with HIV RNA levels of <200 copies/mL, and the couples...

  • HIV Meds Update: HIV in Indiana

    This article describes the CDC investigation and response (through October 2015) to the ongoing HIV (and HCV) outbreak in a rural county in Indiana, centered in people who inject opiates (especially the prescription drug Opana [oxymorphone]). The outbreak was first recognized in...

  • Accessibility: The Bigger Picture

    I have been working on website accessibility for many years in my role as Production Manager at the UCSF Center for HIV Information. Despite that experience, I still encounter problems that confound me. I recently reached out to an accessibility expert for ideas on how to manage a particularly...

  • Use of Dolutegravir in Dialysis

    Dolutegravir has several characteristics that, in theory, suggest it will not be significantly removed by dialysis: It has a large apparent volume of distribution (17.4 L) and is highly protein bound (98.9%). A small study of 5 HIV-infected patients with end-stage renal disease undergoing...

  • PrEP: Bone Density Improves after Stopping TDF/FTC

    Tenofovir disoproxil fumarate (TDF) may cause decreases in bone mineral density (BMD) both in HIV-infected patients treated with TDF-containing ARV regimens and in HIV-uninfected persons who use it for PrEP. A substudy of the large iPrEx trial of TDF/FTC PrEP in MSM and transgender...

  • TAF/FTC Coformulation Approved

    The FDA has approved a new 2-NRTI formulation containing tenofovir alafenamide (TAF) 25 mg + emtricitabine (FTC) 200 mg for adults and children ≥12 years of age; its brand name is Descovy. This is a TAF-containing alternative to TDF/FTC (Truvada).

    Recommended dosing is 1 tablet PO daily...

  • Efavirenz, Dolutegravir, and Darunavir: Pharmacokinetics during Pregnancy

    Three studies presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) explored the pharmacokinetics of antiretrovirals administered during pregnancy. These studies support the use of standard-dose efavirenz, once-daily dolutegravir, and BID ritonavir-boosted...

  • FDA Approves New TAF-Containing Analogue of Complera; Complera Approved for Pediatrics

    The FDA has approved a single-pill combination of rilpivirine + emtricitabine + tenofovir alafenamide (TAF); its brand name is Odefsey.

    It is intended for initial treatment of HIV-1-infected persons age 12 years and older whose pretreatment HIV RNA is ≤100,000 copies/mL, or as a substitute...

  • Switching from TDF/FTC to TAF/FTC

    Researchers at the 2016 Conference on Retroviruses and Opportunistic Infections presented results from a randomized double-blind, double-dummy switch study of TAF/FTC. Over 660 patients with virologic suppression on TDF/FTC-containing 3-drug regimens were either switched to TAF/FTC (200/10 mg...

  • Tissue Levels of TAF: Too Low for PrEP?

    A pharmacokinetic study presented at the Conference on Retroviruses and Opportunistic Infections in Boston in February evaluated concentrations of tenofovir (TFV) and TFV-diphosphate (DP) in genital and rectal tissue and in anogenital fluid samples after administration of oral tenofovir...

  • Rilpivirine Updates: Approved for Adolescents; Possible Risk of Depression

    The U.S. Food and Drug Administration has approved rilpivirine for use in adolescents 12 to 18 years of age; it is not recommended for younger children. As in adults, it is suggested for use in ARV-naive individuals with HIV RNA levels of ≤100,000 copies/mL. The dosage is 25 mg...

  • START-ing TEMPRANO: Early Initiation of Antiretroviral Therapy for HIV

    The prevailing opinion among experts regarding the optimal CD4 T-cell count at which to start patients on antiretroviral therapy (ART) has shifted several times during the evolution of HIV treatment. These shifts reflect attempts to strike a balance between preventing HIV-associated illness and...

  • Pyrimethamine Availability

    Pyrimethamine is no longer available in retail pharmacies in the United States, though it is available through a commercial specialty pharmacy program (the application process, approval, and delivery of the medication will take at least 2 days; for information on ordering, click...

  • TAF: New Data on Tenofovir Alafenamide Fumarate


    Tenofovir alafenamide fumarate (TAF) is an investigational prodrug of tenofovir that in studies to date appears to have less renal and bone toxicity than the current tenofovir product, tenofovir disoproxil fumarate (TDF). This is because TAF is metabolized to tenofovir in lymphocytes and...

  • Adult and Adolescent Guidelines: Major Changes

    The U.S. Department of Health and Human Services has released new treatment guidelines for adults and adolescents, and these contain some important changes. Key among these is a major shakeup in the "Recommended Regimen Options" for initial therapy. 

    Efavirenz/TDF/FTC (Atripla) has...
  • Once-Daily Dosing of Lamivudine and Abacavir for Pediatric Patients

    The U.S. Food and Drug Administration has approved once-daily dosing recommendations for lamivudine and abacavir for HIV-infected children. Previously, these NRTIs were approved only for twice-daily dosing in children. The dosing revisions apply to both the oral solution and the tablet...

  • Testosterone Therapy in HIV-Infected Men: Suboptimal Testing for Diagnosis and Monitoring

    Very few data are available to gauge the possible benefits and adverse effects of long-term testosterone supplementation in HIV-infected men. Despite this, and despite concerns about possible risks of testosterone supplementation (eg, cardiovascular events, prostate cancer), testosterone...

  • HIV PrEP and Incident HCV Infection

    Providers at Kaiser San Francisco, which has a large HIV preexposure prophylaxis (PrEP) program, recently published a brief report on 2 patients who developed acute HCV while on HIV PrEP. This reinforces what we might expect--that while PrEP may be effective as an HIV prevention method,...

  • Tenofovir-Containing ART as HBV Prophylaxis

    We all have patients who just don't get a sAb response to hepatitis B (HBV) vaccination even with repeat vaccination or higher-dose vaccine. A recent retrospective look at rates of incident HBV infection in a cohort of HIV-positive men who have sex with men who were on ART indicates that...

  • Switch to TDF/FTC from ABC/3TC Lowers Lipids

    Are you still conflicted about the choice between the NRTI backbones abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC)? A recent report will give you more to consider. It has been observed in other studies that patients on TDF/FTC tended to have lower lipid values than those on...

  • Two New Boosted-PI Coformulations

    Two boosted protease inhibitor (PI) coformulations have just been approved by the FDA. These are:

    Darunavir 800 mg + cobicistat 150 mg (Prezcobix), andAtazanavir 300 mg + cobicistat 150 mg (Evotaz)

    In these fixed-dose combinations, cobicistat is used as the pharmacokinetic booster of the PI...

  • Drug-Drug Interactions: Tenofovir with Boosted PI + Ledipasvir

    It has been reported that the hepatitis C combination medication ledipasvir/sofosbuvir (LDV/SOF, Harvoni), and in particular the ledipasvir component, may increase tenofovir levels in the body. It also is known from previous investigations that ritonavir-boosted protease inhibitors (PIs)...

  • Two New Boosted-PI Coformulations

    Two boosted protease inhibitor (PI) coformulations have just been approved by the FDA. These are:

    Darunavir 800 mg + cobicistat 150 mg (Prezcobix), andAtazanavir 300 mg + cobicistat 150 mg (Evotaz)

    In these fixed-dose combinations, cobicistat is used as the pharmacokinetic booster of the PI...

  • Drug-Drug Interactions: Etravirine with Dolutegravir or Atazanavir

    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/...

  • Cobicistat approved as PK booster

    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/...

  • New Fixed-Dose Combination Pill: Dolutegravir + Abacavir + Lamivudine

    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.

    Dosing is...

  • Elvitegravir Approved as an Independent Medication

    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...

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

    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...

  • Drug Interactions: Integrase Inhibitors and Cations

    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...

  • Efavirenz Updates: Bone Mineral Density & Suicidality

    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 (...

  • Darunavir + Raltegravir without NRTIs: NEAT Study Results

    Over the past few years, numerous studies have examined the use of NRTI-sparing regimens in initial therapy. These regimens generally have not been as effective as standard regimens, for reasons that are not entirely clear, or have had higher rates of toxicity. Two small studies...

  • First-Line Therapy: Raltegravir, Darunavir, or Atazanavir?

    ACTG 5257 is a randomized open-label comparison of 3 ARV regimens for initial therapy: atazanavir + ritonavir (ATV/r), darunavir + ritonavir (DRV/r), or raltegravir (RAL), each in combination with fixed-dose tenofovir/emtricitabine.

    The 3 treatment groups (...

  • What's New on the AETC NRC Website

    This month the AETC NRC is reaching a milestone in a year-long process to update and upgrade our website. If you are reading this blog post, you are one of our new website's visitors. The biggest changes may be behind the scenes -- we moved all of our content into a new content management system...

  • Dolutegravir Receives FDA Approval

    The integrase inhibitor dolutegravir (brand name: Tivicay) was approved by the U.S. Federal Drug Administration in August, for use in treatment-naive and treatment-experienced adults, as well as for children aged ≥12 years (and weight ≥40 kg) who have not previously taken integrase inhibitors....

  • Updated Occupational PEP Guidelines

    Updated guidelines for management of occupational exposures to HIV were published by the U.S. Public Health Service in September. Among many important recommendations, the new guidelines:

    Eliminate assessment of exposure severity as a means of determining the number of PEP drugs Recommend PEP...
  • Updated Opportunistic Infections Guidelines

    Introduction

    New guidelines for OI prevention and treatment include major updates to all sections of the document. There are numerous changes in the recommendations for prevention, diagnosis, and management. Among the highlights are the following.

    TreatmentCMV retinitis

    Intravitreal...

  • Dolutegravir More Effective Than Raltegravir in Treatment-Experienced Patients

    The investigational integrase inhibitor dolutegravir has been studied in treatment-naive patients and in treatment-experienced patients with integrase inhibitor-associated resistance. The present study (SAILING) evaluates dolutegravir in 715 patients who had resistance to at least...

  • Fast Takes: Darunavir Once-Daily Dosing for Children

    The FDA recently approved revisions to the pediatric dosing recommendations for darunavir tablets and oral suspension. Once-daily dosing of darunavir + ritonavir is recommended for children 3 years of age and older, and >10 kg in weight, who are treatment naive or whose HIV virus does not...

  • Comparison of 2 Tenofovir Prodrugs: TAF (GS 7340) and TDF

    Tenofovir alafenamide fumarate (TAF) is an investigational prodrug of tenofovir. You will recall that the current tenofovir product, tenofovir disoproxil fumarate (TDF), also is a prodrug; so why are we interested in a new prodrug? This largely has to do with efforts to decrease...

  • Interactions with Hepatitis C Protease Inhibitors

    Rilpivirine and Boceprevir

    Boceprevir (BOC) is a hepatitis C virus (HCV) NS3/4A protease inhibitor used in combination with pegylated interferon + ribavirin for the treatment of HCV. As BOC is an inhibitor of hepatic cytochrome (CYP) 3A4, and many protease inhibitors and NNRTIs affect or are...

  • Dolutegravir in Initial Therapy: Two Phase 3 Studies

    Dolutegravir (formerly known as S/GSK 572) is an investigational integrase inhibitor that is in the late stages of development. It is administered once daily and does not require pharmacokinetic boosting. Two recently presented Phase 3 studies evaluated dolutegravir in combination...

  • Elvitegravir as Effective as Raltegravir in Treatment-Experienced Patients

    Elvitegravir is a once-daily integrase inhibitor that requires PK boosting with either ritonavir or cobicistat. It recently received FDA approval for initial therapy as part of a fixed-dose combination that includes cobicistat, tenofovir, and emtricitabine (Stribild).

    ...
  • Cobicistat as a PK Booster of Atazanavir

    Cobicistat is a derivative of ritonavir and a potent inhibitor of CYP3A. As does ritonavir, it "boosts" blood levels of other substrates of this enzyme but, unlike ritonavir, it has no activity against HIV. It has been developed as a pharmacokinetic enhancer of the integrase...

  • More on Interactions between Darunavir and Pravastatin: To Use or Not to Use?

    Recommendations for coadministration of pravastatin with darunavir have been based on a small PK study that showed substantial intersubject variability in the impact of interactions between the two drugs.[1] In that study, concurrent administration of pravastatin (40 mg, single...

  • More on Protease Inhibitors and Corticosteroids

    It has been demonstrated previously that ritonavir significantly increases serum levels of inhaled and intranasal fluticasone and that coadministration with fluticasone should be avoided. Few studies have examined interactions between PIs and other corticosteroids. At the 19th...

  • ARV Interactions with HCV Serine Protease Inhibitors

    Boceprevir and telaprevir, the hepatitis C virus (HCV) serine protease inhibitors, are likely to play important roles in the treatment of individuals with HIV/HCV coinfection, as well as in persons with HCV monoinfection. However, both boceprevir and telaprevir are inhibitors and substrates of...

  • Switching from Efavirenz to Rilpivirine

    It has been reported previously that efavirenz reduces serum levels of rilpivirine and that this effect may be prolonged, even after discontinuation of efavirenz (see Sustained Effect of Efavirenz on Rilpivirine Serum Concentrations). A small, nonrandomized study was designed to answer the...

  • Once-Daily Etravirine

    The NNRTI etravirine is approved for twice-daily dosing in both treatment-naive and treatment-experienced patients. The pharmacokinetic characteristics of etravirine suggest it may be given once daily, and several recent trials have examined the efficacy of QD etravirine.

    In particular,...

  • Winter 2011-12: ARV Fast Takes

    Rilpivirine Added to DHHS RecommendationsRaltegravir-Associated Skin ReactionsDarunavir Oral Suspension

    Rilpivirine Added to DHHS Recommendations

    Recommendations for use of the recently approved NNRTI rilpivirine have been added to the U.S. Department of Health and Human Services adult and...

  • Darunavir + Raltegravir without NRTIs, revisited

    In early 2011, a single-arm study of the NRTI-sparing regimen of darunavir/ritonavir (800/100 mg QD) plus raltegravir (400 mg BID) reported worrisome rates of virologic failure, particularly among subjects with baseline HIV RNA levels of >100,000 copies/mL.(1) At ICAAC, researchers involved...

  • AETC NRC Website: Taking an Iterative Approach to Design

    The National Resource Center website has nearly 1,000 active pages and many "moving parts." Even though it uses modern technical approaches that make updates easier than they would have been in the old days, (e.g., cascading style sheets, a version control system, and templates) implementing...