NEW HIV MEDICINES REGIME TO START HIV TREATMENT IN ADVANCED COUNTRIES LIKE USA,CANADA,UK FOR LESS TOXICITY & COST

In Canada and other high-income countries there are at least 24 anti-HIV drugs from which doctors can choose when writing a prescription. A combination of at least three of these drugs, chosen from different classes, is commonly called ART (the older name is HAART). This apparent abundance of choice masks an underlying reality -- many of the drugs listed are older, are not as effective and are not as well tolerated as newer therapies.To help guide doctors, nurses and patients when making decisions about the initial use of ART, the U.S. Department of Health and Human Services (DHHS) have greatly simplified the recommendations for the initial therapy of HIV. The guidelines now state that the initial regimen should be based on a backbone of either integrase inhibitors or a protease inhibitor. This has resulted in just five regimens being recommended.

INTEGRASE INHIBITOR BASED REGIME:----

• dolutegravir + Truvada (a single pill containing tenofovir + FTC or Emtricitabine
• Stribild -- a fixed-dose combination of elvitegravir + cobicistat + Truvada. Elvitegravir is an integrase inhibitor. Cobicistat is a boosting agent that raises and maintains levels of elvitegravir in the blood so that once-daily dosing is possible.
• raltegravir (an integrase inhibitor sold under the brand name Isentress) + Truvada

A protease inhibitor-based regimen

• darunavir (a protease inhibitor sold under the brand name Prezista) + a small dose of ritonavir (Norvir) + Truvada

Although ritonavir is a protease inhibitor, when used in low doses it acts to boost and maintain levels of darunavir (or other drugs) so that once-daily dosing is possible.

Although not mentioned in the guidelines, a new fixed-dose formulation of darunavir + the booster cobicistat has become available in Canada and other high-income countries. This new formulation is called Prezcobix.

The updated recommendations from the DHHS have surprised some people because therapies that were once commonly favoured even a few years ago -- efavirenz (Sustiva, Stocrin and in Atripla), Kaletra (lopinavir + ritonavir), atazanavir (Reyataz) + ritonavir, and rilpivirine (Edurant and in Complera and Eviplera) -- have been left behind.

The recommendations for the regimens for first-line (initial) therapy use are largely based on the results of large, well-designed clinical trials.