Categories
HIV

How long should i take PrEP HIV?

Good day I’m asking for a friend (I already have HIV so PrEP is not something I need.) Say if my friend go on a months holiday to somewhere he is highly likely to engage in risky sex. Is it viable to use PrEP just for this trip? How long before the first sexual encounter does he need to take PrEP and how long does he need to stay on it after the last sexual encounter? for example in Bangkok PrEP is available from red cross at a cost below a dollar a day. Would this be a good option (together with condoms) for a short trip of say a few weeks to a month?

Response from Dr. Young

While PrEP is typically recommended as a daily medication, for those who have periods of no risk (ie, sexual or injection drug activity), it’s reasonable to consider limiting the treatment time.

I conservatively recommend that people with possible HIV exposures be taking PrEP for at least 1 week prior to the exposure and for a month afterwards.

Categories
HIV

TENVIR EM = Truvada?

Is there a difference in protection between Tenvir em and Truvada?

 

Response from Dr. Young

A quick Google search will reveal that Tenvir EM contains tenofovir DF and emtricitabine, and is a generic version of Truvada. There should be no difference in effectiveness between the two.

Categories
HIV

Once daily dosing of isentress

Hello Dr. I know Isentress is available for once-daily dosing. This new dosage is two 600-mg tablets taken once a day. I am currently on 400 mg tablets taken twice a day. Although it would be easier to take a medication just once a day, wouldn’t I be better off to continue to take it twice a day if I can get the same effect but have to take 400 mg less of the drug daily? Wouldn’t that be a little easier on my kidneys to have to process less of a drug?

 

Response from Dr. Young

Yes, there is a new once-daily formulation of the HIV integrase inhibitor raltegravir, called Isentress HD. Isentress HD differs from the original twice-daily Isentress in formulation, resulting in better drug levels over a 24 hour period. Isentress HD is taken as 2, 600 mg tablets once daily while Isentress is 400 mg twice daily. The two cannot be interchanged. In a large clinical trial, there was no difference in effectiveness toxicity or side effect profile between the two formulations.

Since raltegravir (like other HIV integrase inhibitors) is metabolized by the liver, there’s no effect on kidneys.

We’ve found that our clinic patients who are taking twice daily Isentress have successfully transitioned to the newer, once-daily Isentress HD without issue, and indeed, most prefer the once-daily dosing, even if their daily pill number didn’t change.

Categories
HIV

TENVIR EM + RALTEGRAVIR

HI, I AM FROM INDIA .MY FATHER IS 62 YEARS AND IS A CARDIAC PATEINT WITH DIABETES AND IS DIAGNOSED WITH HIV1 6 MONTHS BACK. WE STARTED THE TREATMENT WITH VIRADAY (CIPLA) (ATRIPLA) BUT AFTER 1.5 MONTHS OF MEDICATIONS SIDE EFFECTS WE REALISED IT WAS DUE TO VIRADAY SO WE CHANGED TO ON TENVIR EM (TRUVADA I.E TENOFOVIR AND EMTRICITABID) FOR ALMOST 3 MONTHS HIS CD 4 COUNTS AT BEGINNING WAS 267 VIRAL LOAD WAS 46,990 COPIES. AFTER 1.5 MONTHS OF ATRIPLA HIS CD4 WAS 218 AND VIRAL LOAD WAS 257 COPIES THEN WE SWITCHED TO TRUVADA I.E TENVIR EM AFTER 3 MONTHS OF IT HIS CD4 IS 459 AND VIRAL LOAD IS BELOW 20 COPIES. NOW THE DOCTOR IS SAYING IS TO ADD RALTEGRAVEER AS ITS NOT SUGGESTED TO BE ON 2 DRUGS . HE IS EMPHASIZING TO BE ON 3 DRUGS AND DOSAGE SHOULD RALTEGRAVEER IN MORNING AND TENVIR EM IN EVENING 12 HOURS GAP IS NECCESARY. I REQUEST TO SUGGEST ME WHAT SHOULD I DO AS ITS DIFFICULT TO FIND A GENUINE ADVICE HERE AND HAS VERY LIMITED DOCTORS IN THE CITY. THE ONLY HOPE IS THE ONLINE FORUM AND GENUINE FORUMS LIKE YOURS.

REGARDS AND THANKS IN ADVANCE. NAMS

 

Response from Dr. Young

Hello Nams and thanks for posting from India.

The use of Tenvir EM (tenofovir+emtricitabine) we call it Truvada here) alone is definitely suboptimal for the treatment of HIV; two drug therapy is not recommended as the risk of developing drug resistance is greater.

It’s not certain from your post if the <20 copy VL was obtained before or after the Tenvir EM alone- if it’s the former, I’d have concern about if the viral load was still suppressed prior to the addition of raltegravir. If it’s the later, this is excellent news- as it indicates that there was no emergence of virus or drug resistance.

Regarding the current regimen, Tenvir EM is dosed once daily, raltegravir twice daily (they can be taken together); and the timing of the second dose need not be exactly 12 hours apart; I recommend in the morning and evening only.

Categories
HIV

Learn more about Isentress

Isentress 400mg (Raltegravir)
Product Name
Isentress 400mg (Raltegravir) 60 Tablets/Pack

Active Ingredient
Raltegravir

Manufacturer
Merck Sharp & Dohme

Product Type
Antiretroviral (HIV)

 

Isentress tablets 400mg contain the antiretroviral drug raltegravir that is used to treat Human Immunodeficiency Virus (HIV) infection in combination with other HIV medications.

Isentress general information

What is Isentress used for?

Isentress tablets 400mg are used to treat Human Immunodeficiency Virus (HIV) infection, in combination with other HIV medications.  This combination therapy is known as highly active antiretroviral therapy (HAART).  HIV impairs the immune system by attacking specific immune cells called CD4+ cells that are involved in fighting infection, which can lead to opportunistic life-threatening infection (infections that would not normally be harmful).  If too many CD4+ cells are destroyed this can result in acquired immune deficiency syndrome (AIDS).  Isentress tablets 400mg help prevent or slow down the ability of HIV to replicate, which reduces the viral load by keeping the amount virus down to a low level and this results in an increase in CD4 cell numbers, so that the immune system can recover reducing the risk of disease progression.

How does Isentress work?

Isentress tablets 400mg contains the antiretroviral raltegravir, an integrase strand transfer inhibitor.  Raltegravir in Isentress tablets 400mg inhibits the catalytic activity of HIV integrase, an HIV-encoded enzyme that is required for viral replication.  HIV is a retrovirus, which is an RNA virus that produces an enzyme called reverse transcriptase to transcribe its RNA into DNA.  Another viral enzyme, integrase, is used to insert or integrate viral DNA into the host cell genome during the early phase of infection.  By blocking the action of viral integrase, raltegravir in Isentress tablets 400mg prevents replication of the virus and thereby inhibits production of new infectious viral particles.  Isentress tablets 400mg slow down the replication of HIV within your body but does not kill the virus already incorporated in the CD4+ cells or prevent the spread of the infection to others.

What does Isentress contain?

Isentress tablets 400mg contain the active ingredient raltegravir, an antiretroviral used in the treatment of Human Immunodeficiency Virus (HIV) infection.  They also contain microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407, sodium stearyl fumarate, magnesium stearate.

Treating HIV infection with Isentress

Isentress tablets 400mg contain the antiretroviral drug raltegravir, an inhibitor of the viral integrase enzyme.  HIV impairs the immune system by attacking specific immune cells called CD4+ cells that are involved in fighting infection, and this can lead to opportunistic life-threatening infection (infections that would not normally be harmful), including pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infection.  If too many CD4+ cells are destroyed this can result in acquired immune deficiency syndrome (AIDS).  HIV is a retrovirus, which is an RNA virus that produces an enzyme called reverse transcriptase to transcribe its RNA into DNA.  Another viral enzyme, integrase, is used to insert or integrate viral DNA into the host cell genome during the early phase of infection.  Raltegravir in Isentress tablets 400mg works by blocking the action of the viral integrase and this inhibits viral replication and thereby inhibits production of new infectious viral particles.  Isentress tablets 400mg are used in combination with other HIV medications to slow down the replication of HIV within your body but they do not kill the virus already incorporated in the CD4+ cells or prevent the spread of the infection to others.

What are the side effects of Isentress?

The most commonly reported side effects when taking Isentress tablets 400mg include: nausea, vomiting, headaches, tiredness, inflammation of the nasal passages and throat, trouble sleeping, upper respiratory tract infection, cough, fever, bronchitis, back pain and depression.  A more serious but less common side effect is a condition is a severe skin reaction including Stevens-Johnson syndrome and toxic epidermal necrolysis.

When should Isentress not be used?

You should not use Isentress tablets 400mg if you:

  • are allergic to raltegravir or any ingredients in Isentress
  • are pregnant or are breastfeeding
  • are taking medicines that interact with Isentress, including antacids containing aluminium and/or magnesium, the anti-infective rifampicin

How should Isentress be taken?

You should take your Isentress tablets 400mg with a glass of water twice daily, with or without food and in combination with other antiretroviral drugs that have been prescribed.  You should continue to take your Isentress tablets 400mg for as long as recommended by your doctor, and you will be monitored carefully to ensure that you do not develop any serious side effects, in which case your doctor will probably recommend that you stop taking your Isentress tablets 400mg.

How long should you take Isentress?

You should continue to take your Isentress tablets 400mg for as long as recommended by your doctor, and you will be monitored carefully to ensure that you do not develop any serious side effects, in which case your doctor will probably recommend that you stop taking your Isentress tablets 400mg.

Missed dose of Isentress

If you miss a dose of Isentress tablets 400mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Isentress be stored?

You should store your Isentress below 25°C in a cool dry place.

Categories
HIV

Learn more about Tenvir-em

Product Name
Tenvir-EM 30 Tablets/Pack [PrEP]
Also known as Truvada or PrEP

Active Ingredient
Emtricitabine and Tenofovir Disoproxil Fumarate

Manufacturer
Cipla Pharmaceuticals

Product Type
Antoretroviral (HIV)

Tenvir-EM tablets contain emtricitabine and tenofovir, which are antiretroviral drugs used to treat HIV infection, to prevent or slow down the spread of infection.

Tenvir-EM general information

What is Tenvir-EM used for?
Tenvir-EM tablets are a fixed dose combination treatment for Human Immunodeficiency Virus (HIV) infection in adults over age 18. Tenvir-EM tablets are used combination with other medications that have a different mechanism of action to the components in Tenvir-EM, and are used to treat patients with HIV infection who have either already received treatment with other medications for HIV or as first line therapy for treatment-inexperienced patients. HIV impairs the immune system by attacking specific immune cells called CD4+ cells that are involved in fighting infection and this can lead to opportunistic life-threatening infection (infections that would not normally be harmful); also if too many CD4+ cells are destroyed this can result in acquired immune deficiency syndrome (AIDS). Tenvir-EM tablets prevent or slow down the ability of HIV to replicate and spread, which keeps the amount of virus down to a low level and this results in an increase in CD4 cell numbers, so that the immune system can recover, reducing the risk of disease progression. Tenvir-EM may be used for Pre-exposure prophylaxis (PrEP) treatment. PrEP is a new prevention method in which people who do not have an HIV infection, but may be at high risk, take a Tenvir-EM tablet every day to reduce their risk of becoming infected. Anyone undergoing PrEp treatment should see their healthcare provider every three months for follow-up and testing.

What is PrEP?
PrEP stands for Pre-exposure Prophylaxis. PrEP is a new treatment to help prevent the spread of the human immunodeficiency virus (HIV-1) that causes AIDS. Taken as a once-a-day tablet, along with safe sex practices, Tenvir-EM can help reduce the risk of contracting HIV-1, the virus responsible for AIDS. PrEP is for… 1. HIV-negative men who have sex with men and who are at high risk of contracting HIV-1. 2. Male-Female sex partners where one partner has HIV-1 and the other doesn’t. 3. Males or females that have sex with intravenous drug users at risk of contracting HIV-1. You must commit to taking Tenvir-EM every day and seeing your doctor every three months for follow up care and testing. How to Get Started: Please contact your doctor to discuss and have a HIV test as soon as possible. Tenvir-EM is for individuals for high exposure risk for HIV-1. Tenvir-EM must be taken every day along with safer sex practices. Please take the time to educate yourself about safe sex and ask your doctor for advice.

How does Tenvir-EM work?
Tenvir-EM tablets contain a combination of two antiretroviral drugs, emtricitabine and tenofovir disoproxil fumarate, which are only effective against RNA viruses (retroviruses) like Human Immunodeficiency Virus (HIV). These drugs each work by inhibiting the action of the viral-specific enzyme reverse transcriptase (RT), which is needed for the virus to be able to replicate. Retroviruses convert RNA to DNA, which is then integrated into the DNA of infected immune cells so that the virus can replicate. Emtricitabine and tenofovir disoproxil fumarate are both nucleoside analogue reverse transcriptase inhibitors (NRTI), which means that they block the action of RT by competing with one of the nucleosides needed to transcribe the viral RNA into DNA, becoming incorporated into the chain of newly synthesized viral DNA and preventing it from growing (chain termination). Emtricitabine is an analogue of cytidine and tenofovir is an analogue of adenosine. The combined action of these two antiiretroviral drugs in Tenvir-EM tablets prevents the integration of the virus into the DNA of the infected CD4+ immune cell, which inhibits the replication of HIV so that no more virus can be produced and this reduces the viral load (amount of virus). Tenvir-EM tablets slow down the replication of HIV within your body but does not kill the virus already incorporated in the CD4+ cells or prevent the spread of the infection to others.

What does Tenvir-EM contain?
Tenvir-EM tablets contain two active ingredients, the antiretrovirals emtricitabine (200mg) and tenofovir disoproxil fumarate (300mg) and used to treat HIV infection.

Treating HIV infection with Tenvir-EM
Tenvir-EM tablets contain a combination of two antiretroviral drugs, emtricitabine and tenofovir disoproxil fumarate, which are only effective against RNA viruses (retroviruses) like Human Immunodeficiency Virus (HIV). HIV impairs the immune system by attacking specific immune cells called CD4+ cells that are involved in fighting infection and this can lead to opportunistic life-threatening infection (infections that would not normally be harmful), including pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infection. If too many CD4+ cells are destroyed this can result in acquired immune deficiency syndrome (AIDS). The two antiretroviral drugs in Tenvir-EM tablets each work by inhibiting the action of the viral-specific enzyme reverse transcriptase (RT) which is needed for the virus to be able to replicate. Retroviruses convert RNA to DNA, which is then integrated into the DNA of infected immune cells so that the virus can replicate. The combined action of the two antiretroviral drugs in Tenvir-EM tablets prevents the integration of the virus into the DNA of the infected CD4+ immune cell, which inhibits the replication of HIV so that no more virus can be produced and this reduces the viral load (amount of virus). Tenvir-EM tablets slow down the replication of HIV within your body but does not kill the virus already incorporated in the CD4+ cells or prevent the spread of the infection to others.

What are the side effects of Tenvir-EM?
The most commonly reported side effects when taking Tenvir-EM include: headache, gastrointestinal upset (nausea, diarrhoea, constipation, stomach pain), dizziness, fatigue, rash, difficulty sleeping, abnormal dreams, depression. A more serious but less common side effect is a condition called lactic acidosis which is excess lactic acid in the blood due to liver damage, which may cause pancreatitis, liver failure, or renal failure.

What are the health risks when taking Tenvir-EM?
Lactic acidosis is a rare but potentially fatal condition that has been reported when taking Tenvir-EM tablets. It is caused by a build up of excess of lactic acid in the blood due to liver damage, which is usually associated with hepatomegaly (liver enlargement) with steatosis (build up of fat in the liver) and may cause pancreatitis, liver failure, or renal failure. Symptoms begin within a few months of treatment and include: nausea, vomiting and abdominal pain, difficulty breathing, loss of appetite, weight loss, motor weakness.

When should Tenvir-EM not be used?
You should not use Tenvir-EM if you:

  • are allergic to emtricitabine or tenofovir or any ingredients in Tenvir-EM
  • are pregnant or are breastfeeding
  • have kidney or liver disease
  • have chronic hepatitis B (HBV) infection
  • have a bone disease like osteoporosis without discussion with your doctor
  • are using antiretroviral drugs containing lamivudine or other antiretroviral drugs that work by the same mechanism (nucleoside analogue
  • reverse transcriptase inhibitors NRTI)
  • are taking medicines that interact with Tenvir-EM, including:other retrovirals like didanosine, atazanavir, and ritonavir

What medications interact with Tenvir-EM?
Several medications interact with Tenvir-EM and should either not be taken while you are taking Tenvir-EM or only after discussion and instruction from your doctor:

Drugs that cause a serious reaction with Tenvir-EM: didanosine for HIV
Drugs that affect Tenvir-EM: other retrovirals like ritonavir
Drugs that are affected by Tenvir-EM: atazanavir for HIV

How should Tenvir-EM be taken?
You should take your Tenvir-EM tablets with a glass of water once a day with or without food. You should continue to take your Tenvir-EM tablets regularly for as long as your doctor recommends, and you condition should be monitored. Do not suddenly stop taking your Tenvir-EM tablets as this may increase risk of HIV resistance.

How long should you take Tenvir-EM?
You should continue to take your Tenvir-EM tablets regularly for as long as your doctor recommends, and you condition should be monitored. Do not suddenly stop taking your Tenvir-EM tablets as this may increase risk of HIV resistance.

Missed dose of Tenvir-EM
If you miss a dose of Tenvir-EM take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.

How should Tenvir-EM be stored?
You should store your Tenvir-EM below 25°C in a cool dry place.

Categories
HIV

Ricovir-EM or Tenvir-EM for Prep?

Ricovir-EM is one of the generic drugs that has the same active ingredients as Truvada, but made by a different company. It is being used by people all over the world as a way to access PrEP when Truvada is not readily available or affordable. Although there have no effectiveness studies on Ricovir-EM or Tenvir-EM, they both contain the same ingredients as Truvada, and there has been no reason or hypothesis to suggest one is more effective than the other.

Hope this answers your doubts.

* Tenofovir Disoproxil Fumarate (Tenvir EM)

Tenvir-EM

Product Name
Tenvir-EM 30 Tablets/Pack [PrEP]

Also known as Truvada or PrEP

Active Ingredient
Emtricitabine and Tenofovir Disoproxil Fumarate

Manufacturer
Cipla Pharmaceuticals

Product Type
Antoretroviral (HIV)

 

Note: If you can afford Isentress is better but also more expensive than this.

 

Let’s look at Isentress


Isentress 400mg (Raltegravir)

Product Name
Isentress 400mg (Raltegravir) 60 Tablets/Pack

Active Ingredient
Raltegravir

Manufacturer
Merck Sharp & Dohme (MSD)

Product Type
Antiretroviral (HIV)

Categories
HIV

5th Generation HIV Test

This fifth generation test is the latest HIV screening test in to distinguish between HIV-1 antibodies, HIV-2 antibodies and the p24 antigen.

The 5th generation assay design simultaneously detects and reports:
• HIV Ag-Ab overall result
with
• HIV-1 p24 Ag
• HIV-1 Ab (groups M & O)
• HIV-2 Ab

The assay will have highly sensitive HIV-1 p24 antigen detection, Limit of Detection = 0.33 IU/mL and 5.2
pf/mL, for improved identification of HIV-1 acute infections.
· The assay also has improved earlier seroconversion detection compared to the 4th generation assay.

#The 5th generation test reduces the detection window period – the time between potential exposure and an accurate test result – to 10 to 14 days, leading to faster treatment as well as ability to control the spread of the disease

The 5th Generation HIV test provides more information than ever before about your HIV status. A major advance is that this test can now detect and identify both HIV-1 and HIV-2 antibodies and the p24 antigen individually in one blood sample, therefore specifically informing you which marker is positive.

By reporting on all three markers individually, if you test positive for any of the markers, it will mean that you can begin a more tailored treatment relevant to your needs much faster. The p24 antigen is detectable only in the early stages of an HIV infection, and the antibodies are the marker of a longer term established infection. By reporting on all of them, we can tell whether your HIV infection is more likely to be acute (or recent) or acquired more than three months ago.

HIV 1 and HIV 2 are two different viruses; HIV-1 is the more common virus worldwide, but they do both need different management. Medicines targeting HIV-1 will not usually be effective against the HIV-2 virus which is why it is important to know early on which viral type you have.

With over 33 million people now living with HIV globally, it is increasingly important to know your HIV status.

Note: 5th Generation HIV Test is a lab Test. As of today, there are no 5th Generation HIV Test Kit yet.

Categories
HIV

Common Adverse Effects of Antiretrovirals HIV Medications

Class
Drug Name
Common Adverse Effects
NRTI
Stavudine Nausea, vomiting, nerve pain, sunken face
Lamivudine Nausea, vomiting, headache, fatigue
Zidovudine Anemia, nausea, vomiting
Didanosine Headache, nausea, vomiting, diarrhea, nerve pain, sunken face
Tenofovir Rash, diarrhea, nausea, vomiting, kidney problems,
Abacavir Diarrhea, nausea, vomiting, liver problems
NNRTI
Nevirapine Rash, allergic reaction, hepatitis, headache, fatigue
Efavirenz Dizziness, nightmares, rash, insomnia, depression
PI
Indinavir Nausea, vomiting, increased bilirubin levels, kidney problems
Ritonavir Raised cholesterol levels, nausea, vomiting, altered sense of taste
Lopinavir Diarrhea, bloating, increased triglyceride and cholesterol levels, may cause or worsen diabetes
Darunavir Nausea, diarrhea, increased triglyceride and cholesterol levels, headache

Categories
HIV

When to Start Antiretroviral Therapy

NRTI
NNRTI
PI
Stavudine Nevirapine (Hirapine ®) Indinavir (Crixivan ®)
Lamivudine (3TC ®) Efavirenz (Stocrin ®) Ritonavir (Norvir ®)
Zidovudine (Retrovir ®) Lopinavir (Kaletra ®)
Didanosine (Dinex EC ®) Darunavir (Prezista ®)
Tenofovir (Tenvir ®)
Abacavir (Ziagen ®)

HAART is started when CD4 cell counts are less than 350cells/mm³. CD4 is a laboratory marker that is used to assess one’s immune status, with a normal CD4 counts to be between 500-1000 cells/mm³. Evidence states that there is a higher likehood of CD4 normalisation if HAART is initiated earlier.

The first line treatment consists of 2 drugs from the NRTI group and 1 drug from the NNRTI group. This set of medications will be supplied by the Ministry of Health for life if patients are successfully treated on the first line treatment. Second-line treatment consists of 2 NRTIs and 2 PIs, but one of the PI drugs will have to be purchased by the patient, whilst the remaining medications will be supplied by the Ministry of Health.

The selection of the antiretroviral regimen is based on several factors including comorbid conditions such as cardiovascular disease, liver disease or tuberculosis, pregnancy, potential drug interactions, gender, baseline CD4 counts and patient adherence potential.