Beginning antiretroviral therapy for patients with HIV

Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate is Non-inferior to Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate in Treatment-naive Adults With Human Immunodeficiency Virus-1 Infection: Week 48 Results of the DRIVE-AHEAD Trial

Background

Doravirine (DOR), a novel non-nucleoside reverse-transcriptase inhibitor (NNRTI), is active against wild-type Human Immunodeficiency Virus (HIV)-1 and the most common NNRTI-resistant variants, and has a favorable and unique in vitro resistance profile.

Methods

DRIVE-AHEAD is a phase 3, double-blind, non-inferiority trial. Antiretroviral treatment–naive adults with ≥1000 HIV-1 RNA copies/mL were randomized (1:1) to once-daily, fixed-dose DOR at 100 mg, lamivudine at 300 mg, and tenofovir disoproxil fumarate (TDF) at 300 mg (DOR/3TC/TDF) or to efavirenz at 600 mg, emtricitabine at 200 mg, and TDF at 300 mg (EFV/FTC/TDF) for 96 weeks. The primary efficacy endpoint was the proportion of participants with <50 HIV-1 RNA copies/mL at week 48 (Food and Drug Administration snapshot approach; non-inferiority margin 10%).

Results

Of the 734 participants randomized, 728 were treated (364 per group) and included in the analyses. At week 48, 84.3% (307/364) of DOR/3TC/TDF recipients and 80.8% (294/364) of EFV/FTC/TDF recipients achieved <50 HIV-1 RNA copies/mL (difference 3.5%, 95% CI, -2.0, 9.0). DOR/3TC/TDF recipients had significantly lower rates of dizziness (8.8% vs 37.1%), sleep disorders/disturbances (12.1% vs 25.2%), and altered sensorium (4.4% vs 8.2%) than EFV/FTC/TDF recipients. Mean changes in fasting low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) were significantly different between DOR/3TC/TDF and EFV/FTC/TDF (−1.6 vs +8.7 mg/dL and −3.8 vs +13.3 mg/dL, respectively).

Conclusions

In HIV-1 treatment-naive adults, DOR/3TC/TDF demonstrated non-inferior efficacy to EFV/FTC/TDF at week 48 and was well tolerated, with significantly fewer neuropsychiatric events and minimal changes in LDL-C and non–HDL-C compared with EFV/FTC/TDF.

Clinical Trials Registration

NCT02403674

Profile of antiretroviral agents use in Colombia

INTRODUCTION

Since the beginning of the epidemic, human immunodeficiency virus (HIV) has taken more than 36 million lives.

OBJECTIVE

To determine the antiretroviral drug prescription patterns in a population of individuals with HIV infection in Colombia.

MATERIALS AND METHODS

Cross-sectional study analyzing the profiles of patients treated with antiretroviral drugs between April 1st and September 30th, 2015. The sociodemographic, pharmacological, and comorbidity variables were identified. Individuals with a positive diagnosis of HIV of all ages and both genders were included.

RESULTS

We found 641 patients with a mean age of 39.0±17 years who were predominantly male (60.2%). The most used medications were lamivudine-zidovudine (51.6%), lopinavir-ritonavir (36%) and efavirenz (24.5%). The combination of lamivudine-zidovudine plus lopinavir-ritonavir was the most prescribed regimen (29.5%), but a total of 80 different regimens was identified. Being an adult between the ages of 45-64 years (OR=2.25; 95%CI 1.367-3.713) was associated with a greater probabilityof receiving 4 or more antiretrovirals. A total of 267 (41.6%) patients used at least one comedication (range: 1-18 drugs), especially anti-ulcer (57.3%), lipid-lowering (28.8%) and anti-hypertensive (28.5%) drugs.

CONCLUSIONS

Patients undergoing antiretroviral treatment are receiving medications with elevated intrinsic values at the recommended doses and present comorbidities associated with chronic agerelated conditions. However, these patients receive a great variety of regimens that are not included in the clinical practice guidelines.

Antiretroviral Therapy for Prevention of Human Immunodeficiency Virus Infection

Human immunodeficiency virus (HIV) infection is considered a chronic medical condition. Several new drugs are available, including fixed-dose combination tablets, that have greatly simplified combination antiretroviral therapy (ART) regimens to treat HIV, while increasing the life-expectancy of infected individuals. In the last decade, multiple well-regarded studies have established the benefits of using ART in high-risk, HIV-negative persons to prevent HIV acquisition. The primary care provider must not only understand commonly encountered issues pertaining to ART, such as toxicities and drug interactions, but also needs to be aware of using ART for HIV prevention.

HIV therapy-the state of art

HIV Attachment. In this cross section, HIV is shown at the top and a target cell is shown at the bottom in blues. HIV envelope protein (A) has bound to the receptor CD4 (B) and then to coreceptor CCR5 (C), causing a change in conformation that inserts fusion peptides into the cellular membrane Antiretroviral therapy changed the face of HIV/AIDS from that of soon and certain death to that of a chronic disease in the years following introduction of highly active antiretroviral therapy in 1995-1996 (initially termed HAART, but now most often abbreviated to ART since not all combinations of regimens are equally active). Since then, many new agents have been developed and introduced in response to problems of resistance, toxicity, and tolerability, and great advances have been achieved in accessibility of HIV drugs in resource-poor global regions. Potential challenges that providers of HIV therapy will face in the coming decade include continuing problems with resistance, especially where access to drugs is inconsistent, determining how best to combine new and existing agents, defining the role of preventive treatment (pre-exposure prophylaxis or PrEP), and evaluating the potential of strategies for cure in some populations.