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.
Bisphosphonates medications (Fosamax, Boniva, Alendronate) are commonly used in the treatment of bone diseases such as osteoporosis, Paget disease, and multiple myeloma, and to limit bone pain and hypercalcemia associated with malignant metastatic bone lesions.
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.
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.
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.
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.