September Spotlight on Health

                    Gateway Apothecary

  September Spotlight on Health

4473 Forest Park Avenue      St. Louis, MO  63108         (p) 314-381-1818       (f) 314-667-3202

Modern day research has given us many options to treat HIV with that are both safe and effective. However, there are a number of up and coming treatments for HIV on the horizon that might be even better. Combination pills make HIV treatment easy and convenient by allowing patients to take one pill once a day. There are a number of new one pill regimens on the horizon. One of which is called the "Trii" tablet, which would combine Tivicay with Epzicom. Both of these medications are approved separately and constitute a complete integrase inhibitor based regimen.

One common HIV therapy used today is efavirenz (Sustiva), which is a non-nucleoside reverse transcriptase inhibitor (NNRTI). This is contained in the one pill regimen Atripla, and can cause patients to experience dizziness, nightmares, abnormal dreams and insomnia. A new NNRTI therapy being developed by Merck is called doravirine. Preliminary studies have shown it to have similar virologic response rates to Sustiva with fewer incidence of side effects. Currently, doravirine is in the process of advancing into phase 3 clinical trials.

In the case of Reyataz and certain other medications, the drug levels don’t get high enough in the body to be effective. In these cases, a booster such as Norvir is used. However, a new medication called cobicistat developed by Gilead has been shown to be equally effective as a booster and has the potential for less side effects. It is contained in the four medication combination pill Stribild. Unlike Norvir, cobicistat has no antiretroviral activity. It merely stops the body from breaking HIV medication down as fast, allowing the drugs to become more concentrated and more effective. Cobicistat is also desirable over Norvir because it's smaller and will allow combination pills to be easier to swallow. Cobicistat is currently in the FDA approval process, both alone and in a two drug combination with Reyataz and Prezista. Another component of Stribild, elvitegravir, is in the FDA approval process as well to be used as a single pill as part of a comprehensive HIV regimen.

A majority of today's combination drugs (Atripla, Truvada, Stribild, Complera) contain a  drug called tenofovir disoproxil fumarate. This medication can be damaging to the bones and the kidneys, and this can be an issue in patients with low bone mass or who have pre-existing kidney disease. However, another form of this medication, called tenofovir alafenamide fumarate (abbreviated TAF), is under development by Gilead. This medication is an altered form of the drug that shows promise in being just as effective and safer on both the bones and the kidneys. Gilead is also in the process of developing a combination pill that would contain this new form of the tenofovir.

Although it's less of a concern in the world of HIV medicine today than a few decades ago, some patients still have to take multiple different pills multiple times per day in their regimen. One example of this is Isentress. This is required to be taken twice a day in order to be effective because it doesn't last in the body for a long enough period of time. A new formulation undergoing study is a higher dose extended release form of Isentress. This is taken 1200 mg once a day, compared to 400 mg twice a day, which is the current way that Isentress is taken.

As modern HIV treatment becomes safer and more potent, there has been research on a two-drug complete regimen for HIV. While only preliminary, the LATTE study has shown that patients with suppressed viral loads who were taking an integrase inhibitor and switched their 2 NRTIs to Edurant had similar proportions of patients with undetectable viral loads. However, larger studies need to be carried out to confirm that patients can have stable disease without NRTIs.  ViiV and Janssen, two prominent pharmaceutical companies that make Tivicay and Edurant, are partnering to develop a combination of these Tivicay and Edurant. This research has also been focusing on long acting versions of Edurant for a once monthly or once every three month regimen for treatment or pre-exposure prophylaxis (PrEP). The purpose of antiretroviral use for PrEP is to reduce or prevent transmission of HIV in high risk individuals. Currently the only medication approved for PrEP is Truvada, which is taken once a day.

With all of the new medication options that are becoming available, HIV medication is becoming easier to handle, and the risk of complications and side effects continues to be lowered. Keep an eye out for these medications and many more to come as new research continues to break new ground and revolutionize the treatment of HIV.

For further information regarding new HIV treatments, contact me at stuart@rx-gateway.com