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Efavirenz
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Alan C. Street, Irani Thevarajan
The preferred nucleoside/nucleotide agent backbone for co-administration with efavirenz is the combination of tenofovir disoproxil fumarate (TDF) plus emtricitabine (available as the fixed-dose combination Truvada) (Panel on Anti- retroviral Guidelines for Adults and Adolescents, 2015). TDF plus emtricitabine plus efavirenz can be administered in a fixed-dose combination (Atripla) as a single tablet once daily. An earlier trial, the Gilead 934 study, demonstrated that combination therapy with TDF plus emtricitabine plus efavirenz was superior to zidovudine plus lamivudine plus efavirenz in terms of virologic suppression, CD4 cell count response, and tolerability (Gallant et al., 2006; Pozniak et al., 2006; Arribas et al., 2007).
The dawn of precision medicine in HIV: state of the art of pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2018
Ying Mu, Sunitha Kodidela, Yujie Wang, Santosh Kumar, Theodore J. Cory
DOR, which is an investigational drug, is under clinical trial for safety and efficacy as both single-drug tablet and fixed-dose combinational tablet with 3TC and TDF. DOR is metabolized through CYP3A4 mostly. It is a P-glycoprotein (PGP) substrate. The range of mean half-life of DOR in patients in fed state was from 11.75 h to 13.1 h, in fasted states ranged from 14.2 to 14.35 h when administered as 100 mg of a single-agent tablet and fixed-dose combination [38]. Viral mutants which are resistant to DOR are susceptible to RPV and EFV, the virus which is resistant to RPV and EFV are susceptible to DOR [39,40]. This made DOR a very promising alternative drug for RPV and EFV. Adverse effects of DOR in the CNS were less common than patients who received EFV in a clinical phase IIb trial. For the fixed-dose tablet clinical trials, the overall adverse effects were compatible except for the effects on low density lipoprotein (LDL) and non high-density lipoprotein (HDL) with DOR reducing and DOR + RTV increasing the level of two lipid parameters between DOR only and DOR + RTV groups [41–43]. Adverse effects such as dizziness, sleep disorders/disturbances, and altered sensorium were significantly less common in the DOR/3TC/TDF group compared with Atripla (EFV/FTC/TDF) group [44,45].
HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda
Published in AIDS Care, 2018
Lisa M. Bebell, Joseph Ngonzi, Mark J. Siedner, Winnie R. Muyindike, Bosco M. Bwana, Laura E. Riley, Yap Boum, David R. Bangsberg, Ingrid V. Bassett
Overall, 481/4231 (11.4%) of participants were HIV-infected, and 92/4231 (1.7%) were missing data on HIV status. Of 481 HIV-infected participants, 480 had one or more temperature measurements, 258 (54%) self-reported CD4 count results, and 83/258 (32%) of these were confirmed by chart review. Another 174/481 (36%) of participants had CD4 testing performed as part of the study. Overall, CD4 count results were available for 442/481 (92%) of HIV-infected participants. Median CD4 count was 487 (interquartile range (IQR) 325, 696) cells/mm3 and did not differ between normothermic and febrile/hypothermic participants (P= 0.96), though normothermic participants were significantly more likely to be taking TMP/SMX prophylaxis (98 vs. 87%, P= 0.002, see Table 2). Of 215/481 (45%) participants randomly selected for in-depth data collection, 193/215 (90%) reported current treatment with combination ART, 11/215 (5%) reported no current ART, and 11/215 (5%) were missing data on this variable. The most commonly reported regimen was combination emtricitabine/tenofovir disoproxil fumarate/efavirenz (Atripla) in 69/215 (32%), while 104/215 (48%) did not know the name of their ART. Of 215 HIV-infected women, 198 (92%) reported current TMP/SMX prophylaxis against opportunistic infections, 6/215 (3%) were not taking TMP/SMX, and 11 (5%) were missing data on this variable (Table 3).
Polypharmacy and risk of falls and fractures for patients with HIV infection and substance dependence
Published in AIDS Care, 2018
Theresa W. Kim, Alexander Y. Walley, Alicia S. Ventura, Gregory J. Patts, Timothy C. Heeren, Gabriel B. Lerner, Nicholas Mauricio, Richard Saitz
Trained research associates administered standardized in-person interviews at study entry and at a 12-month follow-up. Medication data were extracted at study entry from the electronic medical record (EMR) at both recruitment sites. Duplicate medications were removed by cross-referencing the National Drug Code (NDC) number with the generic name as defined in the National Drug File (“Veterans Affairs (VA) National Formulary”). Because multiple NDC numbers exist for the same medication, unique counts of “generic name” were used as a proxy for total number of medications. Combination ARV medications were recoded into individual drug components (e.g., Atripla® was recoded into 3 distinct medications: tenofovir, emtricitabine, and efavirenz). Two of the study investigators (T.K. and A.W.), guided by the U.S. Department of Veterans Affairs Drug Classification System (“Veterans Affairs National Formulary”) classified medications as ‘systemically active,’ sedating/non-sedating, opioid sedating/non-opioid sedating, opioids prescribed for pain/addiction (Figure 1). Sedating medications were those widely known to be sedating. Medications not systemically active included emollients, irrigation solutions, vitamins (except for vitamin D), peritoneal solutions, eye drops, rectal or vaginally administered medications, complementary and alternative medications.