HIV medications: Difference between revisions

Revision as of 12:32, 4 January 2023

Class	Examples	Mechanism of Action	Adverse Effects
Nucleoside reverse-transcriptase inhibitor (NRTI)	tenofovir, emtricitabine, abacavir	Nucleoside/nucleotide analogues that get incorporated into viral DNA by reverse transcriptase, causing missense or non-sense mutations. The backbone of HIV treatments, with a high barrier to resistance.
Non-nucleoside reverse-transcriptase inhibitor (NNRTI)	efavirenz	Actively inhibit reverse transcriptase at its active site. Resistance develops with a single point mutation.
Protease inhibitor (PI)	dirunavir	Inhibits protease, which is required for processing proteins in the creation of the virion.	Metabolic syndrome
Integrase strand transfer inhibitor (INSTI)	raltegravir, dolutegravir, bictegravir		Generally very well-tolerated; may cause weight gain and diabetes
Fusion inhibitor
CCR5 entry inhibitor	maraviroc	Blocks entry of HIV into CD4 cells.
CD4-mAb	ibalizumab

Class	Medication	Abbr	Notes
NRTI	lamivudine	3TC
	emtricitabine	FTC
	tenofovir disoproxol fumarate	TDF
	tenofovir alafenamide	TAF	Fewer renal and bone effects.
	zidovudine	AZT
	abacavir	ABC	Need to check HLA-B*5701 before starting therapy.
NNRTI	efavirenz	EFZ
	nevirapine	NVP
	rilpivirine	RPV	Take with meal, not with PPI.
	doravirine	DOR
PI	lopinavir/ritonavir	LPV/r	GI side effects.
	darunivir	DRV
	ritonavir	RTV
INSTI	dolutegravir	DTG	Increases metformin levels. Avoid in pregnancy.
	elvitegravir/cobicistat	EVG/c	Requires booster that has drug interaction.
	raltegravir	RAL	First INSTI. BID dosing. Only INSTI that can be used in pregnancy.
	bictegravir	BIC
	cabotegravir	CAB	Long-acting injectable available.
	ibalizumab		CD4-receptor antibody.

Brand name	NRTIs	Non-NRTI	First-line?	Notes
Atripla	tenofovir disoproxil fumarate / emtricitabine	efavirenz (NNRTI)	No	Older regimen. Neuropsychiatric symptoms, possibly including suicide. No dose adjustment with rifampin.
Biktarvy	tenofovir alafenamide / emtricitabine	bictegravir (INI)	Yes
Complera	tenofovir disoproxil fumarate / emtricitabine	rilpivirine (NNRTI)	No	Avoid with viral loads (>100,000) or low CD4 (<200). Pill must be taken with food (>400kcal) and without PPIs.
Delstrigo	tenofovir disoproxil fumarate / lamivudine	doravirine (NNRTI)	No
Dovato	emtricitabine	dolutegravir (INI)	Yes	Two-medication regimen
Genvoya	tenofovir alafenamide / emtricitabine	elvitegravir/cobicistat (INI)	No	See Stribild, above.
Odefsey	tenofovir alafenamide / emtricitabine	rilpivirine (NNRTI)	No
Stribild	tenofovir disoproxil fumarate / emtricitabine	elvitegravir/cobicistat (INI)	No	Includes a P450 inhibitor to boost elvitegravir levels, with resultant drug-drug interactions. Avoid if CrCl <70.
Symfi	tenofovir disoproxil fumarate / emtricitabine	efavirenz (NNRTI)	No
Symtuza	tenofovir alafenamide / emtricitabine	darunavir/cobicistat (PI)	No
Triumeq	abacavir / lamivudine	dolutegravir (INI)	Yes	Highest barrier to resistance. Need to test for HLA-B5701 allele before starting. Avoid in hepatitis B coinfection.

@@ Line 4: / Line 4: @@
 !Class
 !Examples
+!Mechanism of Action
-!Description
+!Adverse Effects
 |-
 |Nucleoside reverse-transcriptase inhibitor (NRTI)
 |[[tenofovir]], [[emtricitabine]], [[abacavir]]
 |Nucleoside/nucleotide analogues that get incorporated into viral DNA by reverse transcriptase, causing missense or non-sense mutations. The backbone of HIV treatments, with a high barrier to resistance.
+|
 |-
 |Non-nucleoside reverse-transcriptase inhibitor (NNRTI)
 |[[efavirenz]]
 |Actively inhibit reverse transcriptase at its active site. Resistance develops with a single point mutation.
+|
 |-
 |Protease inhibitor (PI)
 |[[dirunavir]]
-|Inhibits protease, which is required for processing proteins in the creation of the virion. Causes a metabolic syndrome.
+|Inhibits protease, which is required for processing proteins in the creation of the virion.
+|Metabolic syndrome
 |-
 |Integrase strand transfer inhibitor (INSTI)
 |[[raltegravir]], [[dolutegravir]], [[bictegravir]]
+|
-|Extremely potent with few side effects. Take separate from PPIs etc.
+|Generally very well-tolerated; may cause weight gain and diabetes
 |-
 |Fusion inhibitor
+|
 |
 |
@@ Line 29: / Line 35: @@
 |[[maraviroc]]
 |Blocks entry of HIV into CD4 cells.
+|
 |-
 |CD4-mAb
 |[[ibalizumab]]
+|
 |
 |}