Over the past 40 years, there have been groundbreaking advances in the treatment of HIV. People with the infection should be treated as soon as possible following diagnosis. Antiretroviral therapy (ART) should be initiated after the treatment of any opportunistic infections that are present. Initially, ART involves daily oral therapy—typically with a combination including an integrase strand transfer inhibitor (InSTI). Long–acting injectable regimens can also be prescribed to patients who have attained viral suppression, with these injections administered every 2 months.
Two–drug regimens can also be considered, as they reduce the number of agents needed in a comprehensive ART regimen. They should consist of at least one antiretroviral agent with high potency and a high barrier to resistance. Although protease inhibitors (PIs) are non–inferior to three–drug regimens in terms of efficacy and exhibit high barriers to resistance, they are linked to cardiovascular/cerebrovascular disease, along with metabolic adverse effects such as dyslipidemia and insulin resistance. Moreover, drug-drug interactions with PIs can also be an issue.
What are your recommendations for a well–tolerated, unboosted, potent two–drug regimen with a high barrier to resistance for HIV?
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Sara Back, NYC HEALTH AND HOSPITALS - NORTH CENTRAL BRONX (FKA NORTH CENTRAL BRONX HOSPITAL)February 08, 2024I would echo what my colleagues answered: dovato/juluca
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William DeMedioFebruary 02, 2024It’s truly a blessing that we have so many options to treat HIV infection today. A monthly injectable is a great addition. My first patient in medical school had GRID, later called AIDS. It had a greater than 95% mortality rate with a slow, painful death. Now there is a chronic treatable infection.
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Bradley ChappellFebruary 01, 2024Cabenuva is a great injectable monthly option when price is not a consideration, or using vocabria/edurant as the PO equivalent. Otherwise, Dovato & Juluco really are your only current options.
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ADAM ZWEIGJanuary 26, 2024Dovato Juluca
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Sara Back, NYC HEALTH AND HOSPITALS - NORTH CENTRAL BRONX (FKA NORTH CENTRAL BRONX HOSPITAL)January 17, 2024juluca dovato
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Jason Leider, NYC HEALTH AND HOSPITALS - JACOBI (FKA JACOBI MEDICAL CENTER)January 16, 2024Cabenuva & Dovato are 2DR that have high barriers to resistance, excellent efficacy & tolerability.