October Health Corner
Gateway Apothecary
4473 Forest Park Avenue
St. Louis, MO 63108
(p) 314-381-1818 (f) 314-667-3202
Wednesday, October 22, 2014
Wednesday, September 17, 2014
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
Friday, August 1, 2014
Health Corner
Gateway Apothecary
4473 Forest Park Avenue St. Louis, MO 63108 (p) 314-381-1818 (f) 314-667-3202
Ripped from the headlines, the WHO (World Health Organization) and the governor of New York say that you should take PrEP (pre-exposure prophylaxis)…Should you?
The short answer, maybe. Truvada, was approved for the treatment of HIV in 2004 which contains a combination of tenofovir (Viread) and emtricitabine (Emtriva). Truvada is a backbone of most of our current HIV regimens. Most patients who have been diagnosed with HIV have used this medication at times either in a single tablet regimen or in combination with other antiretrovirals. Truvada was approved in 2012 by the FDA for the use of PrEP (pre-exposure prophylaxis), to prevent the spread of the HIV virus before becoming in contact with the contaminated fluids. So should you take Truvada?
All medication has the possibility of side effects and Truvada is no exception. Most patients experience minimal side effects that usually go away within a week or two of therapy, but there are certain patient populations who are unable to take the medication at all. Patients who are allergic to any of the components of Truvada should not take the medication as well as people who have kidney damage or the kidney doesn’t work as well. With my experience Truvada’s most common side effects are stomach upset, diarrhea, dizziness, insomnia and nausea and vomiting. Many people do not have any side effects at all. So does the medication work?
Through clinical studies we have found that there are numerous ways to prevent the spread of the HIV virus. The first and most effective way to prevent the spread of the HIV virus is to treat patients who are currently infected with HIV. If we are able to minimize the circulating virus in an infected patient to undetectable that patient almost has a zero percent chance of spreading the virus. Another effective way to help prevent the spread of the HIV virus is a more universal use of condoms to help stem the spread of the virus. The receptive anal partner has the highest risk of contracting the virus and condoms help put a barrier there to prevent the transmission of the virus. Truvada has been shown to be effective in preventing most of the spread of the HIV virus. There have been numerous clinical studies that have proven that Truvada works to prevent infection when taken every day. Most failures occurred in the studies when the non-infected patient had very little or no medication in their body when they became infected with the HIV virus. So why doesn’t everyone just take the medication?
Well the first problem is the cost. Truvada costs about $1250 per month. Some detractors state that if we are unable to provide care to our current patients who are infected with the HIV virus why would we want to use HIV medications in non-infected individuals. Other detractors say that this will lead to individuals taking Truvada to become more careless and have riskier behavior, like not using condoms, or that the use of an HIV medication will lead to resistance if the patient would become infected with HIV. The clinical studies have shown that the use of PrEP did not show an increase in risky behavior or resistance to the medication. So are you ready to take the medication?
The maker of Truvada, Gilead, has created a website, http://www.truvadapreprems.com/ that shares information for both the patient and the doctor. Patients who want this extra level of protection should talk to their primary care physician or asked to be referred to a specialist who has had experience with the use of Truvada to see if they qualify to use the medication. This isn’t a medication that the physician will just say here is the prescription, go get it filled at your local pharmacy. The FDA has put recommendations together to help providers know what labs that they need to draw and how often the patient should be seen and the regularity of HIV tests.
Remember that this medication needs time to get into the body and be at levels high enough to prevent the infection of the HIV virus. It is recommended that patients take the medication regularly for about a month before they become exposed to the virus. This is not a medication that patients can take on a Friday before going out to a party on the weekend, it needs to be taken consistently on a regular basis. Patients should always use condoms in combination to other preventative methods. If possible know the status of your partner before engaging in intercourse. If you have questions about PrEP please feel free to reach out to me or your medical provider.
Stuart
Stuart Federman Pharm D., AAHIVP
Subscribe to:
Posts (Atom)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.