HIV-positive men and women can now live longer than ever before. A 2013 study found that a newly diagnosed 20-year-old on effective antiretroviral therapy (ART) can expect to live into their 70s, a lifespan only slightly lower than in people without HIV. While this is great news, physicians are learning that chronic HIV infection can place their patients at a higher risk of developing certain health problems earlier in life. One example is heart disease.
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.
Dolutegravir has several characteristics that, in theory, suggest it will not be significantly removed by dialysis:
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 difficult compliance problem.
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.