HIV and ID Observations

December 23rd, 2019

FDA Defers Approval of First Long-Acting HIV Therapy, Surprising Everyone

We HIV/ID specialists are lucky. For over two decades, steady progress in HIV treatment brings regular excitement to our field. Some of these advances are incremental, but others represent major leaps forward. One such example of the latter is long-acting injectable therapy with cabotegravir (CAB) and rilpivirine (RPV) for maintaining viral suppression. This strategy — two […]

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March 9th, 2016

Approval of TAF/FTC/RPV, Another Single Pill HIV Treatment Option

The approval last week of TAF/FTC/RPV — that’s coformulated tenofovir alafenamide, emtricitabine, and rilpivirine — brings us another one-pill, once-daily option for HIV treatment. It’s essentially the same as the existing TDF/FTC/RPV, with similar pros/cons, but with three notable differences coming with the substitution of TAF for TDF. Specifically: Likely reduced renal and bone toxicity. Since approval was based on bioequivalnce, this hasn’t […]

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January 18th, 2016

IV and Injectable HIV Treatments Are Much Discussed — But Won’t Be Here Anytime Soon

Something interesting happens when you poll people who treat HIV — and people who have HIV — about whether they’d prefer a treatment option that consists of a periodic injection or infusion in place of the pill or pills that they take every day. Lots of them say yes. Even people who are taking just one pill […]

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August 28th, 2013

Poll: At $14,105/year, Is Dolutegravir Fairly Priced?

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir:  $12,976 Elvitegravir:  $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir:  $14,105 If […]

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November 2nd, 2012

Antiretroviral Rounds: Resistance on Two Fronts

Got this challenging curbside consult from a colleague, and it has a interesting wrinkle: I have a longstanding patient with HIV who had many failed regimens in the 1990’s with resultant following mutations on a genotype done in 2003: NRTI (M184V, Q151M mutations);  PI (A71, I54V, K20M, L10I, L90M, V82A mutations); no NNRTI resistance. She has been undetectable since then on TDF/FTC/EFV; […]

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August 1st, 2012

Really Rapid Review — 2012 International AIDS Conference, Washington, DC

Last week’s International AIDS Conference in Washington got plenty of media attention, mostly because it was the first time in umpteen years that it was held in the United States, the delay between meetings due to our absurd (and now repealed) immigration laws regarding HIV. (Quick trivia question — where was the conference supposed to be […]

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September 3rd, 2011

“Novel” Approaches to Initial HIV Therapy: Part I

It’s been several years since the “preferred” or “recommended” initial regimens for HIV treatment have been consolidated into one of the following four: TDF/FTC + efavirenz TDF/FTC + atazanavir/r TDF/FTC + darunavir/r TDF/FTC + raltegravir Any room for improvement in this “TDF/FTC + key third drug” approach? With the recent approval of TDF/FTC/rilpivirine, certainly this will […]

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August 11th, 2011

Next Single-Pill HIV Treatment Approved, and It’s Not Called “B-Tripla”

One famous HIV clinician/clinical researcher likens co-formulated TDF/FTC/EFV (Atripla) to a “Godzilla,”  so dominant has the treatment become as initial therapy for HIV. He bases his comments on this study done at his institution, showing that in 2007, fully 85% of patients starting treatment in their clinic began TDF/FTC/EFV. Does this big lizard of a regimen […]

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May 23rd, 2011

Rilpivirine Approved — the “iPod” of NNRTIs?

From the FDA on Friday (it’s always on Friday, isn’t it): FDA approved Edurant (rilpivirine) 25 mg tablets, a new non-nucleoside reverse transcriptase inhibitor (NNRTI) for the treatment of HIV. Rilpivirine is an antiviral drug that helps to block reverse transcriptase, an enzyme necessary for HIV replication. The recommended dose of rilpivirine is one 25 mg […]

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