Emtricitabine/rilpivirine/tenofovir disoproxil fumarate for the treatment of HIV-1 infection in adults

Abstract

This paper reviews the current literature and information on the combination drug Complera(™) (rilpivirine/emtricitabine/tenofovir disoproxil fumarate) that was approved by the Food and Drug Administration (FDA) in August 2011. PubMed, Cochrane and Embase (2001-2014) were searched for primary and review articles on rilpivirine, emtricitabine, and tenofovir disoproxil fumarate, individually or in combination. Data from drug manufacturer and product label was also used. Clinical trial reports were selected, extracted and analyzed to include relevant and recent ones. Selected English-language trials were limited to those with human subjects and included both safety and efficacy outcomes. Results from two phase 3 randomized double blind trials (ECHO and THRIVE) showed that rilpivirine is non-inferior to efavirenz in suppressing viral load below 50 copies/mL in anti-retroviral therapy (ART) naïve human immunodeficiency virus (HIV) infected patients. In addition, psychiatric disturbances, rash and increase in lipid levels occurred less frequently with rilpivirine when compared to efavirenz. However, virological failure and drug resistance were higher with rilpivirine in patients with baseline viral load >100,000 copies/mL. Rilpivirine showed cross resistance to efavirenz and etravirine. Efavirenz, on the other hand, did not demonstrate cross resistance to rilpivirine and etravirine, leaving the latter drugs as options for use in case of virological failure with efavirenz. Complera(™) remains an acceptable alternative treatment to Atripla(™) in ART naïve patients who have a pre-ART plasma HIV RNA <100,000 copies/mL and CD4 count >200 cells/mm(3) with non-inferior efficacy and better safety and tolerability.

Sexually Transmitted Infections in the PReP Era. Are Family Doctors Ready to Give Advice?

“…However, it should be noted that in urine samples, only the indication of infection by N. gonorrhoeae and C. trachomatis is supported by a nucleic acid detection test. 3 The following materials are required for the sample protocol indicated: 2 Dacron swabs, slightly moistened with physiological saline, including 1with Stuart-Amies or similar medium and another with the UTM medium. If possible, direct seeding of the shoot should be performed on a selective agar for gonococcal isolation (GC-LECT agar or similar medium).…”

“…For the cultivation of trichomonas, a Roiron or Diamond medium was inoculated with one of the intakes. 3 If endocervical sampling is not to be performed, the inclusion of a Dacron swab with the UTM medium is acceptable for the detection of C. trachomatis using a nucleic acid detection test. 4 The following materials are required for the indicated sample protocol: 2 dry Dacron endocervical swabs, including Stuart-Amies medium or similar medium and another with the UTM medium.…”

“…2 Treatment can be extended if disease is active after 10 days of therapy. 3 Persons with HIV infection who have primary syphilis should be treated as those without HIV infection. 3 Pregnant women with syphilis at any stage, who report penicillin allergy should be desensitized and treated with penicillin.…”

“…We believe that such practices may lead to a significant increase in the manifestation of STIs as ulcers, such as in syphilis. Thus, a STI poses a significant public health risk in all demographic groups; all physicians should maintain a high level of awareness and should avoid stereotyping patients [3].…”

Renal Dysfunction among HIV-infected Patients on Tenofovir-Based Antiretroviral Therapy at Ronald Ross Hospital in Zambia

“…TDF is an oral prodrug of tenofovir, a nucleotide reverse transcriptase inhibitor (NRTIs) that has been indicated for use from many randomized trials [1,[4][5][6] because of its favorable pharmacokinetic profile, availability as a once-daily fixed dose, good antiviral potency and high tolerability [3,7]. TDF has been considered safe and associated with fewer side-effects in many clinical trials [4,5,8]. However, there have been many case reports, cross sectional and cohort studies describing TDF associated and non-TDF associated nephrotoxicity [9][10][11][12].…”