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The world of HIV medicine is an ever changing place, particularly when it comes to the medication that we need to take to keep us healthy.

Inside your clinic will likely be a team of HIV research nurses and doctors working hard to get you access to the latest treatments out there even before they are licensed and available. These research drugs are exciting; they’ve been tested rigorously before hitting research clinics but still require large published studies before becoming commercially available.

Working in HIV research gives me a great insight into treatment options coming in the near (or distant) future, and having HIV myself, I find it comforting to know that newer treatments are coming out every year which will keep us all ticking along quite nicely!

So what exciting drugs are in the pipeline?

Stribild_bottle_pill_THUMBStribild
So the “QUAD” pill talked about for so long is finally here (with its silly American name). It has its EU licence so it should pop up in your clinic in the upcoming months. It’s a combination of 3 drugs and a booster in one pill. The benefits are that it doesn’t have the central nervous system side effects like ATRIPLA can (the crazy dreams etc) but like all meds can give you a dodgy tummy if you don’t take it with food.

tivicay_435546_437023Dolutegravir
This integrase inhibitor is soon to be upon us, having been trialled throughout the world over the last few years and recently received its American license (Europe shouldn’t be far off). It’s the first once daily integrase inhibitor in a single small pill. The only other integrase inhibitor on the market is Raltegravir – which has to be taken twice a day. Having a once daily integrase inhibitor means adherence should be better and this class of drug is known for crashing your viral load to undetectable super quick! Even more exciting is the ongoing trial where its mixed with Kivexa into one pill meaning another Single Combination Pill is on the way.

Tonofovir Alfenamide Fumerate (TAF)
This is an updated version of the well used NRTI drug Tenofovir Disoproxyl Fumerate currently found in Truvada, Atripla, Eviplera, Stribild and Viread. In a nutshell, they have changed the salt that the drug is attached to which allows it to be given in much smaller doses. The initial data is promising and the hope is that there will be less side effects and smaller pills which leads on to the next exciting drug in progress…

DRV/COBI/FTC/TAF (still to be named)
For people out there on PI based regimes, the years of 3 or 4 pills a day are hopefully coming to an end. Gilead (the drug company behind Atripla, Eviplera, Stribild & Truvada) has teamed up with Jannsen (the makers of Darunavir) to investigate the first Single Combination Pill to include a PI. This in itself is thanks to the discovery of TAF which helps to make this new pill small enough that you could swallow it. It’s still a lot of drug into one tablet so it will be interesting to see how small they can get it. It’s still a few years off but exciting nonetheless.

This means we now have three Single Combination Pills on the shelves in our pharmacies, ATRIPLA, EVIPLERA and STRIBILD and we should have another couple coming in the not-so-distant future. This all adds to an ever growing portfolio of drugs which ultimately means more choice for us – the patients.

Andrew Crawford-Jones
HIV Nurse
Barts Health NHS Trust

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4 COMMENTS

  1. The thing that concerns me about combination drugs is that they could ultimately end up restricting choice: for example the booster drug in stribild isn’t available separately. Combination drugs are great if you can tolerate all the constituent drugs, but if there’s even one drug in the mix you can’t tolerate, then it’s separate pills.

    I’d like to try the new booster in stribild instead of ritonavir if it’s suitable with my other drugs because of the latter’s association with diabetes, which gives me enough trouble as it is without ritonavir adding to it, but that booster (cobicistat?) isn’t available separately.

    Taking a handful of pills isn’t really that much more difficult than taking a single pill (hint: take ’em with milk and they go down more easily), and it doesn’t take long for good adherence to become a matter of habit.

    • Steve,

      I totally understand that taking two or three pills is no more of a challenge that taking one – except for taking up space in your cupboard or suitcase when travelling 🙂

      Cobicistat (named TYBOST) – the gilead booster drug will hopefully be available soon having shown non-inferiority over ritonivir in trials. The EMA has given its approval in the the first stages of its marketing application on 25th July this year for co-administration with Atazanavir or Darunavir. It should get its marketing licence soon and hit the shelves shortly after that although ive not heard any dates yet. I will keep you posted. These things always seem to take forever lol.

      It will be interesting to see how Gilead market it – It would be nice to see it cheaper than Ritonavir which will help stir up the market.

      Its a much more selective booster than ritonavir and hopefully not show the insulin resistance problems that ritonavir has in some patients.

      Hopefully not that much longer to wait 🙂

      Best Wishes

      Andrew

  2. Good news about cobicistat: effects on hyperglycemia are usually the first thing I look for when a new drug is announced – for several years I took an extra 100mg atazanavir instead of boosting it to avoid ritonavir’s effects on lipids and diabetes.

    Something I can’t stand is when people say say of HIV that it’s just like having diabetes. It isn’t: diabetes is far more difficult to live with. If I could get rid of one or the other, I’d get rid of the diabetes!

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