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 darunavir during pregnancy.
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 with boosted PIs, 200/25 mg without boosters) or continued on TDF/FTC; the background third agents were not changed. At 48 weeks, 94.3% of TAF/FTC recipients and 93% of TDF/FTC recipients maintained HIV RNA suppression; the difference was not significant.
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 (switch) regimen for persons who are on a first ART regimen with sustained HIV suppression and no resistance mutations to the ARV components. Recommended dosage is 1 tablet once daily. As with Complera, it must be taken with a meal and cannot be taken concurrently with proton pump inhibitors.
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 alafenamide (TAF). This is of interest because administration of TAF (25 mg orally) results in 90% lower plasma concentrations of the TFV and TFV-DP than TDF, and 7-fold higher levels of TFV in mononuclear cells.
I would like to start this new year introducing myself to the AIDS Education and Training Center (AETC) community. I had the pleasure of joining the AETC National Coordinating Resource Center (NCRC) as a Health Educator in December 2015. I look forward to using my skill set as a Certified Health Educator Specialist and seasoned patient navigator/linkage to care coordinator (LTCC) to provide a perspective based on direct interaction and delivery of care to clients from another standpoint in the healthcare team.
Our understanding of quality in healthcare—how we talk about it and how we measure it—has evolved over time. However, the goal has remained the same: improving the health of people living with HIV. This means constantly challenging ourselves to do better. In essence, do quality improvement (QI) better.
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 daily, to be taken with a meal, and of course in combination with other ARV medications.
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 death and minimizing medication-related toxicity. Two large randomized controlled clinical trials, the START study and the TEMPRANO study, now demonstrate that earlier treatment with ART is most beneficial to boost immune recovery and prevent clinical events.
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 macrophages (as well as hepatocytes and some other cells), whereas TDF is converted to tenofovir in the blood. With TAF, levels of active tenofovir in plasma are about 90% lower, while levels in lymphocytes are higher.