HIV medications: Difference between revisions
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− | ! Medication |
+ | ! Medication !! Abbr !! Class |
− | ! AKA |
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− | ! Class |
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! Notes |
! Notes |
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− | | [[lamivudine]] |
+ | | [[lamivudine]] || 3TC || NRTI |
− | | 3TC |
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− | | NRTI |
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− | | [[emtricitabine]] |
+ | | [[emtricitabine]] || FTC || NRTI |
− | | FTC |
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− | | NRTI |
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− | | [[tenofovir disoproxol fumarate]] |
+ | | [[tenofovir disoproxol fumarate]] || TDF || NRTI |
− | | TDF |
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− | | NRTI |
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− | | [[tenofovir alafenamide]] |
+ | | [[tenofovir alafenamide]] || TAF || NRTI |
− | | TAF |
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− | | NRTI |
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| Fewer renal and bone effects. |
| Fewer renal and bone effects. |
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− | | [[zidovudine]] |
+ | | [[zidovudine]] || AZT || NRTI |
− | | AZT |
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− | | NRTI |
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− | | [[abacavir]] |
+ | | [[abacavir]] || ABC || NRTI |
− | | ABC |
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− | | NRTI |
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| Need to check HLA-B*5701 before starting therapy. |
| Need to check HLA-B*5701 before starting therapy. |
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− | | [[efavirenz]] |
+ | | [[efavirenz]] || EFZ || NNRTI |
− | | EFZ |
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− | | NNRTI |
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− | | [[rilpivirine]] |
+ | | [[rilpivirine]] || RPV || NNRTI |
− | | RPV |
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− | | NNRTI |
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| Take with meal, not with PPI. |
| Take with meal, not with PPI. |
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− | | [[doravirine]] |
+ | | [[doravirine]] || DOR || NNRTI |
− | | DOR |
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− | | NNRTI |
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− | | [[lopinavir/ritonavir]] |
+ | | [[lopinavir/ritonavir]] || LPV/r || PI |
− | | LPV/r |
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− | | PI |
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| GI side effects. |
| GI side effects. |
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− | | [[darunivir]] |
+ | | [[darunivir]] || DRV || PI |
− | | DRV |
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− | | PI |
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− | | [[dolutegravir]] |
+ | | [[dolutegravir]] || DTG || INSTI |
− | | DTG |
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− | | INSTI |
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| Increases metformin levels. Avoid in pregnancy. |
| Increases metformin levels. Avoid in pregnancy. |
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− | | [[elvitegravir/cobicistat]] |
+ | | [[elvitegravir/cobicistat]] || EVG/c || INSTI |
− | | EVG/c |
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− | | INSTI |
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| Requires booster that has drug interaction. |
| Requires booster that has drug interaction. |
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− | | [[raltegravir]] |
+ | | [[raltegravir]] || RAL || INSTI |
− | | RAL |
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− | | INSTI |
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| First INSTI. BID dosing. Only INSTI that can be used in pregnancy. |
| First INSTI. BID dosing. Only INSTI that can be used in pregnancy. |
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− | | [[bictegravir]] |
+ | | [[bictegravir]] || BIC || INSTI |
− | | BIC |
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− | | INSTI |
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− | | [[cabotegravir]] |
+ | | [[cabotegravir]] || CAB || INSTI |
− | | CAB |
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− | | INSTI |
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| Long-acting injectable available. |
| Long-acting injectable available. |
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− | | [[ibalizumab]] |
+ | | [[ibalizumab]] || || |
− | | |
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| CD4-receptor antibody. |
| CD4-receptor antibody. |
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Revision as of 20:23, 12 February 2020
Classes
Class | Examples | Description |
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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-NRTI | 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. |
Integrase strand transfer inhibitor (INSTI) | raltegravir, dolutegravir, bictegravir | Extremely potent with few side effects. Take separate from PPIs etc. |
Fusion inhibitor | ||
CCR5 inhibitor | ||
CD4-mAb | ibalizumab | Blocks entry of HIV into CD4 cells. |
Specific Medications
Medication | Abbr | Class | Notes |
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lamivudine | 3TC | NRTI | |
emtricitabine | FTC | NRTI | |
tenofovir disoproxol fumarate | TDF | NRTI | |
tenofovir alafenamide | TAF | NRTI | Fewer renal and bone effects. |
zidovudine | AZT | NRTI | |
abacavir | ABC | NRTI | Need to check HLA-B*5701 before starting therapy. |
efavirenz | EFZ | NNRTI | |
rilpivirine | RPV | NNRTI | Take with meal, not with PPI. |
doravirine | DOR | NNRTI | |
lopinavir/ritonavir | LPV/r | PI | GI side effects. |
darunivir | DRV | PI | |
dolutegravir | DTG | INSTI | Increases metformin levels. Avoid in pregnancy. |
elvitegravir/cobicistat | EVG/c | INSTI | Requires booster that has drug interaction. |
raltegravir | RAL | INSTI | First INSTI. BID dosing. Only INSTI that can be used in pregnancy. |
bictegravir | BIC | INSTI | |
cabotegravir | CAB | INSTI | Long-acting injectable available. |
ibalizumab | CD4-receptor antibody. |
Single-Tablet Regimens
Brand name | NRTIs | Non-NRTI | First-line? | Notes |
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Atripla | tenofovir disoproxil fumarate / emtricitabine | efavirenz (NNRTI) | No | Older regimen. Neuropsychiatric symptoms, possibly including suicide. |
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) | 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. |
Considerations
- Hepatitis B: Avoid Triumeq; use TDF/FTC-based regimen instead
- CKD: Avoid Stribild in CrCl <70
Further Reading
- Andany N and Gold WL. Five things to know about single-tablet antiretroviral treatment (once daily). CMAJ. 2016;188(13)971.
- Gandhi M and Gandhi RT. Single-Pill Combination Regimens for Treatment of HIV-1 Infection. N Engl J Med. 2014;371:248-259.