HIV and ID Observations

One of the stupid things about being an HIV/ID specialist is the highly arcane code we use to abbreviate HIV treatments.

Why was zidovudine originally AZT, and now ZDV?

Why is lamivudine 3TC?

And tenofovir TDF?

Of course there are legitimate biochemical reasons why these are the right abbreviations, but they are lost to most of us who do not have degrees in medicinal chemistry.

Which is why I would like to share that someone I know — a highly brilliant researcher with dozens of papers in high-profile journals, innumerable grants and awards, and many successful mentored investigators — can’t keep these abbreviations straight.

Example: He recently shortened rilpivirine to RLP.

Sorry, “RLP” isn’t going to cut it. It’s imaginative, and original (I’d wager no one has ever used it before), and starts with the right letter, but someone of his stature would certainly be expected to know that it should be RPV.

Of course, he’s not the only one who has trouble with these tricky abbreviations. Medical students and residents despair at learning them, and ID fellows struggle as if they were learning the coagulation cascade. I recently had one smart and experienced PharmD tell me they were “alphabet soup”, and that the abbreviations for HIV meds always threaten to make any lecture on treatment deadly boring.

With that in mind, here’s some help. In an effort to help struggling Newbies and Full Professors alike learn these key abbreviations, I’ve pasted below three lists — Advanced, Essential, and Basic HIV Medication Lists.

First, Advanced — the whole kit and caboodle, all 27 medications (click to enlarge):

The secret here is that many of these medications are of historical interest only. You don’t really need to know the lousy old meds that are barely ever used anymore — am thinking of you ddI, d4T, SQV, IDV, DLV…

Sure, many HIV/ID specialists pride themselves on knowing all of them — and even more, that they know the years of FDA approval (of the original drug and coformulations), and the trade names. Most will even know the meds that are no longer available — for example, that ddC was the abbreviation for zalcitibine, a horrible NRTI that had the even more horrible brand name Hivid. Good grief, what were they thinking?

Second, the Essential list — the ones that I’d say are critical to know for most HIV/ID specialists. Note that even though several of these drugs are rarely used any longer as initial therapy (e.g., nevirapine, lopinavir), many patients still are on them and doing great — so you’ll still come across these in practice now and again:

With that second list, we’re down to a mere 18 meds. But it can get even simpler, with the Basic list:

Ah, that’s better — now we’re down to just 14 — the antiretrovirals you’re most likely to encounter actually received by a patient in 2015. One might quibble and say that exclusion of lopinavir and maraviroc was unjust, but hey — we’re talking basic here! Learn these first.

Take it away, Trip.

[youtube http://www.youtube.com/watch?v=uQnDqULwPv4]