TOGETHER - POSITIVELY AWARE MARCH+APRIL 2022
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HIV TREATMENT, PREVENTION + HEALTH FROM TPAN
POSITIVELY AWARE
MARCH+APRIL 2022
APART, BUT
THE 26TH ANNUAL HIV DRUG GUIDE
TOGETHER
Separated and isolated by a pandemic,
we still reach out for community
CONTRIBUTORS
THE PHARMACIST THE DOCTOR THE ACTIVIST THE ASSOCIATE EDITOR THE EDUCATOR
Eric K. Farmer, PharmD, Melanie Thompson, MD’s Michael Broder Enid Vázquez has been Carla Blieden, PharmD,
BCPS, AAHIVP, is an career of over three is a 60-year-old gay male Associate Editor of MPH, AAHIVP, completed
HIV clinical pharmacist decades has focused on who tested positive POSITIVELY AWARE her Doctor of Pharmacy,
at the Indiana University ending the HIV pandemic, for HIV in 1990. He ever since she joined Master of Public Health,
Health LifeCare Clinic including conducting grew up in Coney Island the magazine in 1995. and PGY1 Residency at
at Methodist Hospital clinical research for HIV (think: Requiem for a She earned her B.A. in the University of Southern
in Indianapolis, one of treatment and prevention, Dream). As an undergrad, journalism from the California. She is certified
the largest providers advising on HIV policy at he attended Columbia University of Wisconsin- as an HIV pharmacist
of HIV medical services the local and national level, University on a Pulitzer Madison. She interned and has worked as the
in the state of Indiana. developing national and Scholarship. He earned at The Chicago Reporter clinical pharmacist at
He provides pharmacy international HIV treat- an MFA in poetry from and was a cub reporter the Maternal, Child, and
services that include ment and care guidelines, NYU in 2005, and a PhD for The Hartford Courant, Adolescent/Adult Center,
medication adherence and providing medical in Classics from CUNY in the oldest continuously a family-centered HIV
counseling and patient care for people with HIV. 2010. His dissertation published newspaper clinic in Los Angeles, for
education, drug Between 1988 and 2020, was on queer kinship in the United States. over a decade. She works
information services, she conducted over 400 and camp aesthetics in Her freelance work has directly with patients
medication procurement, studies in the areas of HIV Roman satire. He loved appeared in publications focusing on adherence to
medication therapy treatment, prevention and three men who died of around the country. She HIV medication, managing
management, and diagnostics; viral hepatitis AIDS—Randy Snyder, became interested in other chronic diseases,
medical care coordination treatment and diagnostics; universally beloved ACT health reporting because and analyzing HIV
services. He is on the and sexually transmitted UP activist; Tony Salinas, of the importance it has medication resistance.
Board of Directors for infection diagnostics as who played bass with the on people’s lives. It is a Dr. Blieden has been
the American Academy of Principal Investigator rock band Mountain; and privilege to work on behalf working closely with
HIV Medicine and serves of the AIDS Research Marcos Betancourt, who of people living with City of Los Angeles
as clinical faculty for the Consortium of Atlanta was on track to ignite the HIV/AIDS, Enid says. officials and the Los
Midwest AIDS Training (ARCA). She saw her first world. He married the She believes that HIV is as Angeles Fire Department
and Education Center. Dr. patient with HIV in 1982 poet Jason Schneiderman much a condition fueled on deployment of the
Farmer graduated from and has cared for thou- in 2004, in Provincetown, by societal discrimination influenza and COVID
Butler University with his sands of people with HIV in Massachusetts, one of as it is by a virus. As such, vaccinations. Dr. Blieden
Doctor of Pharmacy in Atlanta since that time. the first few hundred gay it makes her reporting is Assistant Professor
2007. He then completed She currently men to get legally civilly socio-political as well of Clinical Pharmacy
an ASHP-accredited co-chairs the HIV married in the United as medical. She enjoys and Director of Student
PGY1 pharmacy Medicine Association States. Currently getting reporting on medical Outreach and Community
residency at Eskenazi (HIVMA) HIV Primary same-sex divorced, he updates and making Health at the USC
FARMER AND VÁZQUEZ: JOHN GRESS • BLIEDEN: ISAAC MORA
Health in Indianapolis, Care Guidance Panel that lives in historic Bed-Stuy, them relatable to readers’ School of Pharmacy.
and subsequently an recently published its Brooklyn, with a number lives. Enid has a special She reviewed the DHHS
ASHP-accredited PGY2 2020 recommendations of feral cats, and the interest in sexual violence guidelines for this guide.
HIV specialty pharmacy for the clinical care of best roommate ever. His and sexual freedom, and
residency at the Center people with HIV in Clinical book of poems, This Life in serving the sex trade
for HIV/AIDS Care and Infectious Diseases in Now, was a finalist for the worker and transgender
Research at Boston November. Lambda Literary Award communities.
Medical Center. Dr. Thompson’s for gay poetry in 2015.
passion is to contribute to
an end to the HIV epidemic
through patient-centered
medical care, prevention
and treatment research,
and evidence-based
guidelines and policy
with a focus on health
inequities.
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EDITOR’S NOTE
JEFF BERRY
@PAeditor
Gratitude
T
his is the 26th Annual POSITIVELY AWARE HIV Drug Guide. I’m incredibly honored
to have served as editor on 18 of these incredible resources for people living
with HIV and those who care for them. This HIV Drug Guide has some changes
to it that we think you’ll like. For the first time we’ve added HIV PrEP to the HIV
Drug Chart that’s in the middle of this issue (we added the PrEP drug pages to
the guide itself a few years ago). We’ve included a statement on Paxlovid from
our amazing physician for this year’s guide, Dr. Melanie Thompson. Paxlovid
is the latest oral medication (under emergency use authorization and not yet
approved) to treat mild to moderate COVID for those at highest risk for severe
I’m grateful to
disease. It contains an old HIV drug (Norvir) that has a lot of interactions with
have lived to see
other drugs, so see the statement on page 17 for more information. the day where
Treatment and prevention for HIV continues to Vázquez and Rick Guasco. You know I love you guys! this revolution in
evolve with long-acting injectable medications now or We drive each other crazy as we get down to the wire treatment is now
soon to be on the market. As this issue went to press, to meet our deadline, but it’s all worth it because of upon us, because
Cabenuva, the first long-acting injectable regimen the end result. We do it for all for you, the people who this is only the
for treatment of HIV, was approved for dosing every are reading this right now!
other month—that’s six doses a year. Wow! What a Enid wanted to make sure that we gave a special
beginning.
long way we’ve come from handfuls of pills two or shout out and thank you to all of the scientists and
three times a day with dreadful side effects—some of providers who make her sister’s continued life and
which weren’t all that effective. I’m grateful to have well-being possible. That goes for all of us living with
lived to see the day where this revolution in treatment HIV—we all thank you for making our lives your life’s
is now upon us, because this is only the beginning. work. We wouldn’t be here (literally) if it wasn’t for you.
Monoclonal antibodies, gene-editing technology, Wherever life leads us, let’s continue to express
mRNA vaccines for HIV, implants, etc.—all of these gratitude to each other and for what each of us brings
advances are mind-blowing and moving at a rapid to the table. I’m grateful for my postal carrier who
pace, and will result in this guide having to evolve delivers the mail (almost) every day. I’m grateful for
as well. A pill chart may soon become a relic of the my therapist who encourages me to keep working
past in the not-too-distant future. We’ll have to come on getting in touch with my best self (and letting go
up with a lot of new categories, symbols, icons—but of the rest). I’m grateful for my coworkers who make
it’s all good, and it will be exciting to be a part of the me laugh and teach me new things every day (at least
future of the HIV treatment and prevention landscape. when I’m in the office). I’m grateful for family and
This is where I have to stop and point out once friends who help me feel connected and keep me
again (I know, I sound like a broken record) that none grounded. And above all I’m grateful to the universe
of it will lead us to the end of the HIV epidemic unless for providing—always.
people have access to these new therapies. We have Thanks to you, our readers, for subscribing to the
to ensure health equity for our Black and Brown magazine, for reading my ramblings, and for joining
brothers and sisters and for all communities that are along with us for this wild ride. Last but not least,
disproportionately affected by HIV. Pricing of these we’re grateful to the frontline workers who are doing
drugs cannot continue to grow exponentially by leaps the work each and every day on behalf of people living
and bounds as the advances in research have—it is with and affected by HIV. Our community has never
just not sustainable, not for our health systems, and been stronger, and I’m so grateful to have been wel-
not for our pocketbooks. Will these new modes of comed into it with open and loving arms.
delivery and novel therapies only be accessible for the
privileged few, while the rest of us are left to swallow Always take care of yourself, and each other.
generic versions of old HIV pills because that’s all our
plans will cover or that we can afford? Let’s hope not.
I’m also honored to work with a great team that
puts this behemoth together year after year, Enid
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BEING BRIDGETTE
BRIDGETTE PICOU
The problem is how
you see the problem
I have a question: Is your HIV a problem for you? Another good example is
Why or why not? If I asked you to identify the biggest love. I hear women say pretty
often “he loves me even with
problem it causes for you—could you? Is it stigma? HIV” or “he loves me in spite
Internalized stigma? Medication adherence? Is it navigating of HIV.” In my head I’ve also
relationships (including the one with yourself)? reframed that idea of being loved
in spite of HIV and changed it to
Next questions: How long using your skills to facilitate being loved with HIV. When we
have you been living with HIV change. do things “in spite of,” it implies
and the same problem(s)? Have All too often in HIV we let the a certain disdain for the thing
your coping skills evolved? Has virus—and other people—define in question. It’s that you don’t
your “problem” changed face us. They label us and come to like it, but you’ll tolerate or live
over the years, or is it the same conclusions about a life they’ve with it anyway. The problem with
one or two on repeat? never lived—and we let them. allowing that is it’s an insidious
Which leads me to this: What We get caught in endless cycles and subtle kind of stigma, both
Problem solving skills do you use to cope with of what we know life could or external and internalized. You’ll
involves looking HIV as a concept, lifestyle, and should be, and yet let stigma and settle for less than you deserve
life process? Don’t worry, I’m shame corner us into feeling dif- in a relationship because after all,
at the problem, not about to tell you what to do ferently. For example, sometimes you do have this thing that needs
defining and or how to do something about it; I would resent taking a pill every to be worked around.
analyzing the I’m not a therapist, and I damn day because I didn’t want to I don’t want to be tolerated on
underlying sure don’t have all the answers. depend on a thing for my health. any level, and in a relationship,
concerns, then I am, however, working on me I’ve reframed the problem—it’s we better be working through,
using your skills and how I see myself, and I just now my opportunity each day to not around, issues that arise.
to facilitate wanna make you take stock of ensure I’m here to do what my Love the whole imperfect
your life with HIV for a second purpose says I need to do and package or leave me alone. The
change. and do the same. I’m more grateful and gracious problem isn’t HIV makes
Consider this notion—which about it. love and relationships
is actually one of my personal hard. The problem
affirmations: The problem is is my relationship
how you see the problem. The with those
Google definition of things and HIV.
problem is “a matter So, let me
or situation regarded ask again:
as unwelcome or Is your HIV
harmful and needing a problem,
to be dealt with and or is how
overcome.” you see the
Just reading the words problem your
“harmful” and “overcome” problem?
invokes some angst, right? I Be well.
came across a definition once You matter.
that seems less negative as it
processes through the brain’s
PICOU: CHAD SAIN • WOMAN: SZEFEI-ISTOCK
gray matter: A problem is the
difference between what is and
what could or should be.
How about that for seeing a
problem differently? I don’t know
about you, but “what could or
should be” makes me feel a little
optimistic as opposed to putting
me in the struggle mindset of
having to overcome. Problem
solving involves looking at the
problem, defining and analyzing
the underlying concerns, then
4 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribe
T H E 2 6 TH A N N U A L H I V D R U G G U I D E
MARCH+APRIL 2022
POSITIVELY AWARE P O S I T I V E LY AWA R E • VO LU M E 32 N U M B E R 2 • posi tivel yaware.com • @pos aware
Jeff Berry
E D I T O R- I N - C H I E F
@PAeditor
EVERY ISSUE
Enid Vázquez
A S S O C I AT E E D I T O R
@enidvazquezpa
3
EDITOR’S NOTE
4
BEING BRIDGETTE
6
BEHIND THE COVER
65
POZ ADVOCATE
Gratitude The problem is Apart, but together The agony of
Andrew Reynolds how you see the Seeking community. defeat—and
H E PAT I T I S C E D I T O R poblem BY RICK GUASCO delayed drug
@AndrewKnowsHepC BY BRIDGETTE PICOU development
BY SCOTT SCHOETTES
Rick Guasco
21–61
C R E AT I V E D I R EC T O R
@rickguasco
C O LU M N I S T S THE 26TH ANNUAL HIV DRUG GUIDE
Bridgette Picou A handbook of the medications used for treating HIV.
Scott Schoettes BY ERIC K. FARMER, PharmD, AND ENID VÁZQUEZ
WITH COMMENTS BY MELANIE THOMPSON, MD, AND MICHAEL BRODER
PROOFRE ADER
Jason Lancaster
PHOTOGR APHERS
10
12 THINGS TO KNOW
17
INVESTIGATIONAL NEW DRUGS
Habeeb Mukasa
John Gress ABOUT HIV TREATMENT This is why clinical trials are done.
Chris Knight When you should start HIV treatment,
ADVERTISING MANAGER
Lorraine Hayes
what does HIV treatment do, and other
essential questions answered. 17
HIV & COVID-19
12
L.Hayes@tpan.com Statement on Paxlovid for people
with HIV on antiretroviral therapy.
DISTRIBUTION MANAGER
Denise Crouch HIV LIFE CYCLE
distribution@tpan.com
SUBSCRIBE OR ORDER COPIES
Different drug classes interrupt the
virus from replicating at various stages. 20
CLASS LIST
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13
DHHS RECOMMENDATIONS
An A-to-Z listing of the medications
in the drug guide.
LIVE LIFE POSITIVELY AWARE. Guidelines for people starting
HIV therapy for the first time. 62
HELP IS OUT THERE
S I N C E 1 9 9 0 , P U B L I S H E D BY
16
LOOKING AHEAD
HIV treatment can be costly,
but there’s help.
5537 N. BROADWAY New drugs in development.
CHICAGO, IL 60640-1405
(773) 989-9400 2022 PULL-OUT HIV DRUG CHART SPONSORED BY
fax : (773) 989-9494
inbox@tpan.com
positivelyaware.com
@PosAware
FOR A LIST OF WALGREENS HIV SPECIALTY PHARMACIES,
AND OTHER RESOURCES, GO TO HIV.WALGREENS.COM
TPAN was founded in 1987
in Chicago as Test Positive Aware
Network, when 17 individuals living
with HIV gathered in a living room
to share information and support
‘As a Black trans woman who has been living with HIV
in response to the HIV/AIDS for over 10 years, I just want to say it’s okay to be
epidemic. POSITIVELY AWARE is nervous and overwhelmed, but dig deep and find that
the expression of TPAN’s mission to
share accurate, reliable, and timely determination and tenacity to survive and thrive so
treatment information with anyone you, too, can motivate and inspire others.’
affected by HIV.
—MALLERY JENNA ROBINSON (SECOND FROM RIGHT, WITH CARLOS MORENO,
BE GREEN. ANDREA DE LANGE, DAMONE THOMAS, AND OLIVER WONG, PAGE 3
SHARE OR RECYCLE
THIS MAGAZINE.
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BEHIND THE COVER
FROM LEFT: ANDREA DE LANGE, DAWN McCLENDON, OLIVER WONG, ALFREDO “FREDDY” FAVELA, CARLOS MORENO, DANIELLE M.
CAMPBELL, MPH, DAMONE THOMAS, MALLERY JENNA ROBINSON, ALICIA MOREHEAD-GEE, MD, JOSÉ MAGAÑA, AND NICHOLAS SNOW.
Apart, but together
F
BY RICK GUASCO
rom the AIDS epidemic of the 1980s through of African descent globally, the are HIV negative to remain
today’s COVID pandemic, people living with decision to pursue this work HIV negative.
was a logical conclusion. So “My turning point in
HIV have endured isolation in one form or many of my people were being facing life with HIV came in
another while reaching for community to find affected, I couldn’t resist join- September 2011,” he says.
support, information, and hope. We might be ing the ranks alongside others “I decided I wanted to live,
alone, but we’re also together. doing this work,” she adds. because there is so much to
gain. Today, I thrive above HIV.”
At 34, Damone Thomas’
That was the theme behind “I have been an HIV advocate HIV journey has taken him As an undergrad at California
the Los Angeles photo shoot since first volunteering in the from Kingston, Jamaica, State University, Northridge,
for the cover (and additional food pantry of an HIV service where he tested HIV positive Alfredo “Freddy” Favela, MPH,
photos) of the 26th annual HIV organization, nearly eight in January 2008, to L.A, where was passionate about sexual
Drug Guide, which brought years ago,” says Danielle M. he is now a health care worker health, often advocating on
together people living with Campbell, MPH, an activist and a retention specialist. campus for safer-sex practices.
HIV—both recently diagnosed and faculty member of the “I learned of my status Pursuing his master’s degree
and long-term survivors—and Charles R. Drew University of when I decided to get tested, in public health with an
care providers in the HIV field, Medicine and Science, a his- despite the fear of being gay emphasis in epidemiology at
all passionate about their work, torically Black college, as well in Jamaica,” he says. “Living Los Angeles Pacific University,
MARK HARVEY
and some living with HIV as as at UCLA and the University with HIV motivates me to work he began focusing on com-
well. They each make a unique of California at San Diego. in the field, to be at the table munities of color. Favela is
contribution, finding a place in “Learning how HIV dispro- to help others living with HIV, now community outreach
the communities they serve. portionately impacted women and try to help people who supervisor and community
6 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribe
engagement lead diagnosed, it’s important to but she was already in A young single mother of two,
at UCLA’s CARE talk with someone who has another abusive relationship. struggling to work and go to
Center. been living with HIV for a lon- “Starting a year before I was school, Dawn P. McClendon
ger time,” he says. “Hearing diagnosed, he treated me shifted gears from becoming
In 2011, Mallery firsthand experiences from a like a leper after I told him a lawyer to promoting public
(“Mally”)Jenna long-term survivor can give my status,” she says. “I let health and to become part of
Robinson was you assurance that HIV is him live with me and treat something larger than her-
studying for a manageable.” me that way for another self. Now 48, she is assistant
double bachelor’s two years because I was so director of the Los Angeles
degree in biology Carlos Moreno, 31, came unempowered and thought County Commission on HIV.
and history in out to his family, friends and I’d never be in a better “I am eternally changed by
Montgomery, coworkers by telling his story relationship.” the relationships I have built
Alabama, when onstage during a concert by Today, de Lange has been with people living with and
she collapsed the Reveille Men’s Chorus in happily married for more impacted by HIV as well as
at the restau- Tucson, Arizona, in May 2015. than 19 years, “to an HIV- those who are a part of this
rant where she “My entire life changed negative guy, who totally workforce, and I am forever
worked. Two after that,” says Moreno, loves and accepts me, HIV grateful,” she says.
weeks later, she whose pronouns include he and all,” she says.
learned she was and they. “I no longer carried José Magaña’s love of help-
living with HIV. the heavy burden of secrecy. After decades of practicing ing people helped him to
“I was This opened up many doors safer sex, Nicholas Snow overcome stigma. He learned
completely for me, and just a couple says it was one moment that of his HIV status about six
overwhelmed as months after coming out, I led to him acquiring HIV in years ago while getting test-
a then-21-year- moved to Los Angeles to August 2007. “I remind myself ed to get onto PrEP.
old Black trans continue expanding my that I am human, and this “I told my sexual partner,
woman, but I was advocacy.” was a human experience,” he and they did not want any-
determined to not For him, being visible says. “I don’t beat myself up thing to do with me,” he says.
let this diagnosis means representing. “Folks for it, and I am loving and for- “It took me a year of therapy
deter me from needed to see people like giving of myself. My greatest to learn to love myself
living my best life,” myself living well, working, power is my ability to live and regardless of my status,
she says. Today, and thriving with HIV, as well express my truth. whether people choose to
she advocates as contributing to the field of “My personal mission accept me or not. Since then,
for women of all service delivery for margin- statement is to honor and I decided to educate and
trans identities alized populations. This was express my creativity in a share my story with others to
and is a mem- something that I struggled way that makes a difference,” get rid of HIV stigma.”
ber of the Los to see in the early years of says Snow, producer and host At 39, public service has
Angeles County my diagnosis. of PromoHomo.TV, an LGBTQ always been part of José
Commission on HIV. “Not everyone gets the online platform. Magaña’s life. He’s been in
“As a Black trans woman chance or has the privilege to “My status doesn’t weigh the Army National Guard for
who has been living with HIV be out about their status, or on me personally, except that 17 years, having spent over a
for over 10 years, I just want to be a community advocate,” stigma and ignorance are still year and half on deployment
to say it’s okay to be nervous they acknowledge, “but know pervasive within the gay male assisting hospital workers
and overwhelmed,” she says, the rest of us do what we do community, which makes it during the COVID-19 pandem-
“but dig deep and find that because we love and honor challenging to find love, but ic. He’s now a community
determination and tenacity you, and carry you with us.” I haven’t given up,” he adds. organizer for The Wall Las
to survive and thrive so you, “What about U=U [undetect- Memorias Project, focusing
too, can motivate and inspire It was 1987, and Andrea de able equals untransmittable, on substance abuse and men-
others.” Lange didn’t fit “the type” the message that a person tal health, and facilitates a
who would have HIV. She had with undetectable viral load virtual group for people living
Being public about his status swollen lymph nodes, and is not able to transmit HIV with HIV that meets every
helped Oliver Wong, 30, her new doctor was trying to a sexual partner] don’t Wednesday night via Zoom.
overcome isolation and stig- to rule out possible causes. they understand?” “I love to help people in
ma. Diagnosed barely a year A cancer screening three the community that I am part
ago, he’s even made it part years earlier had turned out In medical school, Alicia of,” he says. “Everyone has a
of schtick. “As a stand-up negative. Morehead-Gee, MD, MS, 34, different story to tell and it’s
comedian, I also talk about “My doctor never thought was fascinated by the global important to share those sto-
being HIV positive,” he says. I could be HIV positive when impact of HIV/AIDS. At UCLA, ries so that others can learn
“It helps me to share my I got the biopsy, because I her work focuses on HIV and grow from them.”
experience onstage. It’s very didn’t fit the stereotypes of prevention and Black women.
therapeutic, empowering, who was HIV positive, and Today, she’s medical director ABOUT THE PHOTOGRAPHER
and freeing to talk about it. he also didn’t know about of HIV prevention for AltaMed Mark Harvey is a visual artist,
If you’re living with HIV and my past history with the Health Services to expand designer, photographer, and
turn your experience into art boyfriend,” she says. PrEP (pre-exposure prophy- educator living in Los Angeles.
and share it with the world, “The boyfriend,” an injec- laxis) awareness and access. He also teaches a variety of
it’s gonna not only help tion drug user, had turned “My team trains primary topics in graphic design and
you, but also help the world her on to crystal meth, telling care providers, pharmacists, photography at the Art Center,
understand HIV and remove her that she needed to lose and staff on PrEP and PEP Pasadena City College,
stigma. weight. The relationship (post-exposure prophylaxis),” Glendale College, and at
“If you are newly lasted from 1981 to 1985, she says. Los Angeles City College.
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THE BASICS
12 things to know about HIV
1. When should “antiretrovirals” (ARVs). To
HIV treatment start? quickly find your drug, go to
“Getting Around” in this issue. A
It is recommended that every- single-tablet regimen (STR) con-
one living with HIV be on HIV sists of two or more ARVs which
treatment, and as soon as pos- represent at least two drug
sible after diagnosis. So say the classes, and form a complete
HIV treatment guidelines from HIV treatment in one pill taken
the U.S. Department of Health once daily. STRs are widely used
and Human Services (DHHS). by people taking HIV treatment
for the first time (called “treat-
2. What does ment naïve”), but they are not
HIV treatment do? for everybody, including some
people who are treatment-expe-
The goal of therapy is to sup- rienced or have multi-drug resis-
press the amount of virus (called tance. A fixed-dose combination
“viral load”) to an undetectable (FDC) combines two or more
level (meaning that the amount ARVs in one pill but is not always
of virus in your blood is so low, it an entire regimen (an STR is a
cannot be detected by normal type of fixed-dose combination).
tests). This will keep you healthy, We now have a long-acting
and the sooner you start ther- injectable regimen (Cabenuva),
apy, the less damage the virus which at press time consists of a
can do to your immune system one-month oral lead-in followed
so you’ll stay healthier longer. It by two intramuscular injections
also means you can’t transmit administered every four weeks.
HIV to your partner through sex Other long-acting drugs are
when you are on antiretroviral in development; for one that’s
treatment (ART) and undetect- expected to be approved this
able at less than 200 copies for year, see lenacapavir, page 32.
at least six months (undetect-
able equals untransmittable, 6. How should HIV
or U=U; also called “treatment treatment be taken?
as prevention,” or TasP). HIV
treatment should also raise the Getting to and staying undetect-
number of your CD4+ T cells, a able requires adherence: taking
measure of the immune system. your medication as prescribed
(for example, with or without
3. What tests are needed food) and not missing doses.
before starting HIV therapy? Discuss any concerns with your
doctor, nurse, or pharmacist.
You will be tested for STIs, Reach out for support at your
hepatitis B and C virus, and HIV local HIV organization or support
drug resistance. With the “Rapid network. That includes housing
Start” strategy recommended and job opportunities if you need
by DHHS, you will begin treat- them. Anti-stigma efforts are
ment while awaiting test results. also important for HIV care.
Not all HIV meds are recom-
mended for Rapid Start. 7. What is drug resistance?
4. Is HIV treatment a cure? If treatment is not taken
correctly or is unable to com-
Treatment does not cure HIV, pletely suppress the virus, it
but maintains health and, if might mutate (make changes
you’re undetectable, prevents in its viral genetic structure).
transmission. This can make therapy less
effective or even ineffective.
5. What does HIV This drug resistance occurs
treatment consist of? mostly through missed doses.
Fortunately, many of the widely
HIV therapy consists of medi- used HIV drugs today have a
cations from at least two drug high barrier to resistance, are
classes. HIV drugs are called easier to take, and have few if
10 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribe
treatment
any side effects. However, it is contact information and
better to avoid missing doses. their preferred method of
Drug resistance may lead to communication.
the need for more complicated n Remember that nurses and
therapy (such as more pills). pharmacists are also good
sources of information.
8. Which drugs should I use?
10. What is AWP?
HIV treatment is based on
considerations such as health The Average Wholesale Price
status (for example, kidney or (AWP) on each drug page is a
liver disease) and lifestyle. See way to compare costs of drugs.
considerations for therapy in It is not what you would pay if
the DHHS guidelines. you were to pay the full retail
price. (That’s why it’s commonly
9. How can I referred to as “ain’t what’s
address my concerns? paid.”) The drug cost-sharing
and patient assistance program
You can play an active role in charts (beginning on page 62)
your health care by talking to include information on how to
your doctor. Clear and honest access programs that can help
communication between you cover all or part of the costs of
and your physician can help many of these medications.
you both make smart choices
about your health. It’s import- 11. What are PEP and PrEP?
ant to be honest and upfront
about your symptoms even if PEP and PrEP are not HIV treat-
you feel embarrassed or shy. ment, but are HIV medications
Have an open dialogue with used by HIV-negative people to
your doctor—ask questions to prevent infection with the virus.
make sure you understand your “PEP” stands for “post-exposure
diagnosis and treatment. While prophylaxis” and is taken for
ARV regimens are usually well 28 days following a potential
tolerated, each ARV can have exposure to the virus; PEP must
side effects. Some may be seri- be started within 72 hours after
ous. Refer to the drug page for a recent possible exposure.
each individual drug. Each per- “PrEP” stands for “pre-exposure
son is different; you and your prophylaxis” and is taken daily
health care provider will have to to prevent someone from get-
decide which drugs to use. ting HIV. “Prophylaxis” means
Here are a few tips that “preventative.”
can help you talk with your
doctor to make the most of your 12. More information online
appointment:
See considerations for therapy,
n Write down a list of ques- including information on COVID,
tions and concerns before and drug factsheets from DHHS
your appointment. at HIVinfo.nih.gov. DOWNLOAD
n Consider bringing a close iPhone and Android apps that
friend or family member provide drug info, guidelines,
with you. and a glossary: clinicalinfo.hiv.
n Take notes about what the gov/en. The International AIDS
doctor says, or ask a friend Society also produces HIV
or family member to take treatment guidelines. GO TO
notes for you. iasusa.org/resources/guidelines.
n Learn how to access your To see if your HIV drug interacts
medical records, so you can with another medication, either
keep track of test results, prescription or over-the-counter,
diagnoses, treatment GO TO hiv-druginteractions.org.
MARK HARVEY
plans and medications, Among the good community-
and prepare for your next based sources of information,
appointment. besides POSITIVELY AWARE,
n Ask for the doctor’s is aidsmap.com.
positivelyaware.com/subscribe | M A R C H + A P R I L 2 0 2 2 11
POSITIVELY AWARE 2022 HIV DRUG GUIDE
HOW HIV DRUGS WORK
HUMAN
IMMUNODEFICIENCY
VIRUS (HIV)
HIV life cycle
Different drug classes interrupt the virus
from replicating at various stages
CD4
RECEPTOR
ANTIRETROVIRAL THERAPY works by
CCR5
targeting more than one stage in the CO-RECEPTOR
HIV life cycle. Combining certain drugs
from more than one drug class will
achieve this goal, and suppress the virus
to undetectable levels in the blood. The
compounds listed under the stages below
are new drugs in development.
1
2
CD4 CELL
➊ BINDING 3
HIV binds to the surface of a host cell.
ENTRY INHIBITORS
➋ FUSION 4
HIV’s RNA reverse transcriptase,
integrase, and other viral proteins
fuse to the host cell.
FUSION INHIBITOR
MONOCLONAL ANTIBODIES (mAb)
in development:
• UB-421 (CD4 receptor)
• VRC01 (CD receptor)
• 3BNC117/LS and 10-1074/LS 5
• PGDM1400 and PG121
10E8.4, etc.
• PRO-140 (CCR5 receptor) 6
• albuvirtide
7
➌ REVERSE TRANSCRIPTION
Viral DNA is formed by reverse
transcription.
NRTIs and NRTTIs (nukes), including ➏ ASSEMBLY
SOURCES: PUBLIC HEALTH LIBRARY/CDC AND HIV i-BASE (i-BASE.INFO)
these in development: New viral RNA and proteins move to
• islatravir the cell’s surface; a new, immature
NNRTIs, including these in (and non-infectious) virus forms.
development: PROTEASE INHIBITORS, including
ILLUSTRATION BY ABBEY DENLINGER ©POSITIVELY AWARE
• elsufavirine this one in development:
• GS-1156
➍ INTEGRATION NEW
Viral DNA is transported into the host COPIES ➐ BUDDING
cell’s nucleus and integrates into the OF HIV The virus becomes infectious when
host’s DNA. protease breaks up proteins in the
INTEGRASE INHIBITORS immature virus to create the mature
• GS-9883 virus that goes on to infect other
CD4 cells.
* CAPSID INHIBITOR in development:
➎ REPLICATION
• lenacapavir
MATURATION INHIBITOR
New viral RNA is used as genomic in development:
RNA and to make viral proteins. • GSK3640254
* IN MARCH 2021, RESEARCHERS ACCEPTED
THAT THE CAPSID UNCOATS IN THE NUCLEUS
12 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribePOSITIVELY AWARE 2022 HIV DRUG GUIDE
DHHS RECOMMENDATIONS
DHHS Guidelines for people starting HIV therapy for the first time
The expert panel of the U.S. Department of Health and Human Services recommends starting antiretroviral
therapy (ART) as soon as possible after HIV is diagnosed, regardless of CD4 count. Most people starting
HIV treatment for the first time (treatment-naïve) should take one of the following: Biktarvy, Dovato, Triumeq,
or Tivicay plus Descovy or Truvada. GO TO hivinfo.nih.gov for more information.
★ Recommended initial regimens for most people with HIV
Recommended regimens are those with demonstrated durable
virologic efficacy, favorable tolerability and toxicity profiles, and ease of use.
INSTI + 2 NRTIs INSTI + 1 NRTI
Except for individuals
with pre-treatment HIV
viral load greater than
500,000 copies/mL,
who are known to have
active hepatitis B virus
(HBV) co-infection,
or who will start ART
before results of HIV
genotype testing for
Biktarvy Triumeq Dovato reverse transcriptase
BIC / FTC / TAF DTG / ABC / 3TC DTG / 3TC or HBV testing are
A1 (if HLA-B*5701-negative) A1 available.
A1
INSTI + 2 NRTIs
WITH OR
Tivicay Descovy Truvada
DTG FTC / TAF A1 FTC / TDF
✔ Recommended initial regimens in certain clinical situations
These regimens are effective and tolerable, but have some disadvantages when compared
with the regimens listed above, or have less supporting data from randomized clinical trials.
However, in certain clinical situations, one of these regimens may be preferred.
INSTI + 2 NRTIs
OR WITH OR
Isentress HD (two tablets once daily) Descovy Truvada
or Isentress (1 tablet twice daily) FTC / TAF FTC / TDF
RAL B2 B1
RATING OF RECOMMENDATIONS THE FOLLOWING ARE AVAILABLE AS CO-FORMULATED DRUGS
A: Strong B: Moderate C: Optional (NOT A COMPLETE LIST)
RATING OF EVIDENCE Atripla: EFV/FTC/TDF Biktarvy: BIC/FTC/TAF Cimduo or Temixys: 3TC/TDF
1: Data from randomized controlled trials. 2: Data from well- Complera: RPV/FTC/TDF Delstrigo: DOR/3TC/TDF Descovy: FTC/TAF
designed non-randomized trials, observational cohort studies Dovato: DTG/3TC Epzicom: ABC/3TC Evotaz: ATV/c
with long-term clinical outcomes, relative bioavailability/ Genvoya: EVG/c/FTC/TAF Odefsey: RPV/FTC/TAF Prezcobix: DRV/c
bioequivalence studies, or regimen comparisons from Stribild: EVG/c/FTC/TDF Symfi: EFV 600 mg/3TC/TDF
randomized switch studies. 3: Expert opinion. Symfi Lo: EFV 400 mg/3TC/TDF Symtuza: DRV/c/FTC/TAF
Triumeq: DTG/ABC/3TC Truvada: FTC/TDF
positivelyaware.com/subscribe | M A R C H + A P R I L 2 0 2 2 13POSITIVELY AWARE 2022 HIV DRUG GUIDE
DHHS RECOMMENDATIONS
✔ Recommended initial regimens in certain clinical situations (continued)
Boosted PI + 2 NRTIs
(In general, boosted DRV is preferred over boosted ATV.)
OR +
Prezcobix Prezista Norvir
DRV / COBI DRV 800 mg RTV
WITH
Symtuza
DRV / COBI / FTC / TAF
B1 OR
Descovy Truvada
FTC / TAF FTC / TDF
A1
OR + WITH OR
Evotaz Reyataz Norvir Descovy Truvada
ATV / COBI ATV RTV FTC / TAF FTC / TDF
B1
OR + WITH
Prezcobix Prezista Norvir Epzicom
DRV/ COBI DRV 800 mg RTV ABC / 3TC
B2 if HLA-B*5701 negative
NNRTI + 2 NRTIs
WITH
Delstrigo Pifeltro Descovy
DOR / 3TC / TDF DOR FTC / TAF
B1 B3
14 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribe✔ Recommended initial regimens in certain clinical situations (continued)
NNRTI + 2 NRTIs
3TC may substitute for FTC and vice versa
WITH
Atripla Symfi Symfi Lo Sustiva Descovy
EFV 600 mg / FTC / TDF EFV 600 mg / 3TC / TDF EFV 400 mg / 3TC / TDF EFV 600 mg FTC / TAF
B2
B1 B1 B1
If viral load is less than
100,000 copies/mL Odefsey Complera
and CD4 count is more RPV / FTC / TAF RPV / FTC / TDF
than 200 cells/mm3 B2 B1
Boosted INSTI + 2 NRTIs
Genvoya Stribild
EVG / COBI / FTC / TAF EVG / COBI / FTC / TDF
B1 B1
✔ Regimens to consider when ABC, TAF, and TDF cannot be used or are not optimal
Except for individuals
with pre-treatment HIV
viral load greater than
500,000 copies/mL,
who are known to have
+ WITH
active hepatitis B virus
(HBV) coinfection, or
who will start ART before
results of HIV genotype Dovato Prezista Norvir Isentress
testing for reverse
DTG / 3TC DRV 800 mg RTV (one tablet twice daily)
transcriptase or HBV
testing are available A1 If viral load is less than 100,000 copies/mL RAL
and CD4 count is more than 200 cells/mm3
C1
+ WITH
Prezista Norvir Epivir
DRV 800 mg RTV 3TC
C1
positivelyaware.com/subscribe | M A R C H + A P R I L 2 0 2 2 15Looking ahead
What’s on the horizon—new drugs in development
RECENTLY APPROVED PHASE 2
Cabenuva GSK3640254
(cabotegravir LA/rilpivirine LA) A maturation inhibitor with Phase 2a
Two long-acting drugs from INSTI results in HIV-positive participants.
and NNRTI families that are given From ViiV.
by intramuscular injection and that
have very long half-lives—detect- PHASE 1–3 and PRE-CLINICAL
able after more than one year
following single dose. CAB LA + 3BNC117, 10-1074, PGDM1400,
RPV LA injections were studied PGT121, 10E8, UB-421, etc.
for treatment, and CAB LA is being Many bNAbs (broadly neutralizing
studied for prevention as single antibodies) are in development
INSTI injection. From ViiV/Janssen. for HIV prevention, treatment,
See page 31. and cure, often in dual or triple
combination (see “Scenes from
PHASE 3 the bNAb Revolution” in the
January+February 2020 issue).
islatravir/3TC/doravirine Potential as switch option without
Fixed-dose combination of the ART and in current studies for use
NNRTI doravirine plus generic 3TC as PrEP.
and NRTI islatravir (EFdA). From
Merck. On partial clinical hold (see Albuvirtide + 3BNC117
sidebar). Albuvirtide is a fusion inhibitor,
approved in China, that is being
islatravir/doravirine developed in the U.S. by Frontier
Dual FDC with NNRTI doravirine. Biotechnologies in combination with
From Merck. On clinical hold (see the bNAb 3BNC117 for use in treat-
sidebar). ment-experienced patients.
leronlimab (PRO 140) GS-1156
Monoclonal antibody CCR5 target. Once-daily unboosted protease
Once-weekly (350–700 mg) subcu- inhibitor; high potency, long half-life,
taneous injection being studied in potential for fixed-dose combination
addition to oral ART for multi-drug single-tablet regimen. From Gilead.
resistance and as monotherapy
maintenance therapy (without oral GS-9883
ART). From CytoDyn. Long-acting formulation of the
integrase inhibitor bictegravir. From
PHASE 2/3 Gilead.
islatravir (EFdA)
A new NRTI, highly potent, low dose, ADAPTED in part from HIV Pipeline
active against NRTI resistance. Long 2021: New Drugs in Development,
half-life, potential as oral (daily, published by HIV i-Base, September
weekly dose for treatment; perhaps 2021. Accessed online January 27,
monthly for PrEP) and implant 2022. For the full report, GO TO i-base.
(annual implant for PrEP). From info/htb/41142.
Merck. On full and partial clinical
hold (see sidebar). ALSO SEE HIV life cycle on page 12.
lenacapavir (GS-6207)
New drug class (capsid inhibitor)
with activity at multiple stages of
viral lifecycle. Subcutaneous injec-
tion every six months. It is being
studied simultaneously for treat-
ment and prevention. From Gilead.
MARK HARVEY
Submitted for approval in U.S. in
July 2021 (see page 32). On clinical
hold (see sidebar).
16 M A R CH+A PRIL 202 2 | positivelyaware.com/subscribeHIV & COVID-19
Statement about
Paxlovid for
people with HIV on
antiretroviral therapy
Investigational new drugs Paxlovid is approved under
Emergency Use Authorization
BY MELANIE THOMPSON to treat COVID-19 in persons
at high risk for serious out-
At the end of 2021, clinical trials of two promising agents screeched to a halt, comes. It is a two-drug regi-
disappointing many who were excited about the prospects for long-acting HIV men of the protease inhibitors
treatment and prevention with islatravir and injectable lenacapavir. This is nirmatrelivir and ritonavir and
why we do clinical trials, though, and they did their jobs correctly. Shout out is given twice daily for five
also to independent Data Monitoring Committees. days, beginning as soon as
possible after diagnosis of
On November 16, Merck stopped its study of once weekly oral islatravir COVID-19. As we know from
and MK-8507, an investigational long-acting NNRTI, because the external decades of use in HIV treat-
Data Monitoring Committee (eDMC) detected a decrease in total lympho- ment, ritonavir has many drug
cytes and T cell counts with the combination. At the time, the changes interactions that should be
seemed to be related to the dose of MK-8507. The next week, Merck and carefully considered before
Gilead temporarily paused enrollment into the much-anticipated trial of starting Paxlovid. A state-
once-weekly oral islatravir and lenacapavir. On December 6, at the recom- ment from the HIV Medicine
mendation of its eDMC, Merck paused enrollment in its two IMPOWER trials Association of the Infectious
of once-monthly oral islatravir for PrEP. Just a week later, the FDA placed a Diseases Society of America
partial clinical hold on seven oral islatravir/doravirine trials (no new enroll- recommends that people with
ment, but existing participants continue to get medication) and a complete HIV can take Paxlovid even
hold on six other islatravir treatment and prevention trials, including oral, if they are on a regimen con-
injectable, and implant formulations. At the same time, Merck and Gilead taining ritonavir or cobicistat,
also stopped dosing in a study of oral islatravir and lenacapavir. This may not but monitor for side effects.
portend the death of islatravir, but it is too soon to tell. This is reiterated in the EUA
package insert for Paxlovid.
Lenacapavir, Gilead’s first-in-class capsid inhibitor, was being studied However, Paxlovid may
for treatment and prevention via subcutaneous injection every 6 months. interfere with other drugs
Obviously, it needed a suitable partner for treatment, and islatravir appeared you are taking, which would
to be an excellent choice. Gilead quickly submitted a New Drug Application require holding other drugs
for lenacapavir based on promising 26-week results of the phase 2/3 temporarily or changing their
CAPELLA trial in heavily treatment-experienced patients with multidrug dosage or, possibly, not taking
resistant virus. As with the pivotal trial of fostemsavir, the primary endpoint Paxlovid. If you are going to
was change in HIV RNA after 14 days of functional monotherapy, followed take Paxlovid for COVID-19,
by optimization of the background therapy (OBT) and open label lenacapavir. be sure to tell your care pro-
There was also a separate nonrandomized cohort who started LEN and OBT vider about all the medicines
from Day 1. These data were presented last July at the IAS Conference. The you take, including those that
combination of injectable lenacapavir and an injectable version of islatravir are over the counter.
was on the horizon until the FDA hold on islatravir stopped the phase I trial of
the injectable formulation. Statement from
HIVMA and IDSA
For an even worse end to 2021, on December 21, Gilead announced that idsociety.org/globalassets/
the FDA had placed a clinical hold on injectable lenacapavir in all ongoing covid-19-real-time-learning-
studies for treatment and prevention, due to concerns about the safety of network/patient-populations/
the borosilicate glass vials. Both enrollment and dosing were stopped in 10 hiv/oral-covid-tx-
ongoing trials. If there is good news here, it is that there was no concern considerations-for-people-
expressed about lenacapavir itself, so one hopes that Gilead will quickly solve with-hiv-and-hcv.pdf
this problem and continue on with the trials. However, if problems with isla-
travir are not solved, it will also be a setback for lenacapavir and LEN will be Statement from the
looking for another date to the prom. COVID19 Treatment
Guidelines
Still in the pipeline are ViiV’s maturation inhibitor GSK-3640254 (called covid19treatmentguidelines.
GSK-254); albuvirtide, a fusion inhibitor being developed by Frontier nih.gov/therapies/statement-
Biotechnologies; and a host of broadly neutralizing antibodies (bnAbs) on-paxlovid-drug-drug-
being studied alone and in combinations for treatment, prevention, and interactions/
cure. It’s clear that 2022 will be an interesting year in HIV drug development.
Get your popcorn! FDA Emergency Use
Authorization Fact Sheet
about Paxlovid
fda.gov/media/155050/
download
positivelyaware.com/subscribe | M A R C H + A P R I L 2 0 2 2 17POSITIVELY AWARE 2022 HIV DRUG GUIDE
Class list
In this guide, HIV drugs are grouped into nine categories
—plus, additional categories for select non-HIV drugs and PrEP
STR LA CAI INSTI PI PKE NRTI NNRTI EI/AI
SINGLE-TABLET LONG-ACTING LONG-ACTING INTEGRASE STRAND PROTEASE PHARMACOKINETIC NUCLEOSIDE NON-NUCLEOSIDE ENTRY INHIBITOR/
REGIMEN INJECTABLE CAPSID ASSEMBLY TRANSFER INHIBITOR INHIBITOR ENHANCER REVERSE REVERSE ATTACHMENT
(MULTIPLE REGIMEN INHIBITOR (INTEGRASE (BOOSTER) TRANSCRIPTASE TRANSCRIPTASE INHIBITOR
DRUG CLASSES) INHIBITOR) INHIBITOR INHIBITOR
(“NUKE”) (“NON-NUKE”)
PAGE BRAND NAME CATEGORY GENERIC NAME
29 Atripla STR efavirenz/emtricitabine/tenofovir DF (EFV/FTC/TDF)
21 Biktarvy STR bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF)
31 Cabenuva LA cabotegravir/rilpivirine long-acting (CAB LA/RPV LA) injectable
41 Cimduo NRTI * lamivudine/tenofovir DF (3TC/TDF)
28 Complera STR rilpivirine/emtricitabine/tenofovir DF (RPV/FTC/TDF )
26 Delstrigo STR doravirine/lamivudine/tenofovir DF (DOR/3TC/TDF)
39 Descovy NRTI * emtricitabine/tenofovir alafenamide (FTC/TAF)
23 Dovato STR dolutegravir/lamivudine (DTG/3TC)
47 Edurant NNRTI rilpivirine (RPV)
43 Emtriva NRTI emtricitabine (FTC)
44 Epivir NRTI lamivudine (3TC)
42 Epzicom NRTI * abacavir/lamivudine (ABC/3TC)
36 Evotaz PI / PKE atazanavir/cobicistat (ATV/COBI)
27 Genvoya STR elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/COBI/FTC/TAF)
50 Intelence NNRTI etravirine (ETR)
34 Isentress HD INSTI raltegravir (RAL)
32 lenacapavir CAI lenacapavir (LEN )—NOT YET APPROVED AT PRESS TIME
24 Juluca STR dolutegravir/rilpivirine (DTG/RPV)
37 Norvir PKE ritonavir (RTV)
28 Odefsey STR rilpivirine/emtricitabine/tenofovir alafenamide (RPV/FTC/TAF)
48 Pifeltro NNRTI doravirine (DOR)
35 Prezcobix PI / PKE darunavir/cobicistat (DRV/COBI)
35 Prezista PI darunavir (DRV)
36 Reyataz PI atazanavir sulfate (ATV)
53 Rukobia AI fostemsavir (FTR)
51 Selzentry EI maraviroc (MVC)
27 Stribild STR elvitegravir/cobicistat/emtricitabine/tenofovir DF (EVG/COBI/FTC/TDF)
49 Sustiva NNRTI efavirenz (EFV)
30 Symfi/Symfi Lo STR efavirenz/lamivudine/tenofovir DF (EFV//3TC/TDF)
25 Symtuza STR darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/COBI/FTC/TAF)
41 Temixys NRTI * lamivudine/tenofovir DF (3TC/TDF)
33 Tivicay INSTI dolutegravir (DTG)
22 Triumeq STR dolutegravir/abacavir/lamivudine (DTG/ABC/3TC)
52 Trogarzo EI ibalizumab-uiyk (IBA)
40 Truvada NRTI * emtricitabine/tenofovir DF (FTC/TDF)
38 Tybost PKE cobicistat (COBI)
45 Viread NRTI tenofovir disoproxil fumarate (tenofovir DF, or TDF)
46 Ziagen NRTI abacavir sulfate (ABC)
* Fixed-dose combination of two drugs from the same drug class.
HIV PRE VENTION
57 Apretude for PrEP PrEP cabotegravir extended-release injectable suspension (CAB LA)
58 Descovy for PrEP PrEP emtricitabine/tenofovir alafenamide (FTC/TAF)
59 Truvada for PrEP PrEP emtricitabine/tenofovir DF (FTC/TDF)
NON-HIV DRUGS
60 Egrifta SV tesamorelin for injection for HIV-related hard belly fat
60 Mytesi crofelemer for HIV/AIDS-associated diarrhea
61 Serostim somatropin for injection for HIV-related wasting
20 M A R CH+A PRIL 202 2 | positivelyaware.com/hiv-drug-guidePOSITIVELY AWARE 2022 HIV DRUG GUIDE
Biktarvy bictegravir/emtricitabine/tenofovir alafenamide
BIC/FTC/TAF
Single-tablet regimen
STR containing an INSTI and two NRTIs ★ Recommended initial regimen for most people
n STANDARD DOSE DR. MELANIE THOMPSON: avoided by the switch, address-
One tablet once daily without regard to food for people taking HIV Small and potent, Biktarvy ing a common polypharmacy
treatment for the first time (treatment-naïve) or individuals with sup- is a popular “go-to” initial issue in older persons who have
pressed viral load on a stable HIV regimen with no history of treat- therapy, including for same- multiple comorbidities. Never
ment failure and no known resistance to components of the regimen: day HIV treatment start. It has take Biktarvy with dofetilide, a
bictegravir, emtricitabine, or tenofovir. Tablet contains 50 mg of the a high resistance barrier. A heart rhythm medicine, as levels
INSTI bictegravir plus 200 mg emtricitabine and 25 mg TAF. recent randomized open label of defetilide are increased and
study, GS-380-4030, found that serious rhythm disturbances
For adults and children weighing at least 55 pounds (25 kg), use individuals with suppressed could occur. Biktarvy increases
standard dose above or see package labeling. New pediatric formula- virus on DTG + TDF/FTC or TAF/ metformin levels and the metfor-
tion available for children at least 2 years old and weighing 30.8–55 FTC could safely switch to min dose may need to be adjusted
pounds (14–25 kg), Biktarvy Low Dose—use one tablet daily with or Biktarvy even in the presence of if there are side effects. Several
without food. Each Biktarvy Low Dose tablet contains BIC 30 mg/FTC some previous NRTI resistance, medications for seizures or tuber-
120 mg/TAF 15 mg. Take missed dose as soon as possible, unless it is including the M184V mutation culosis cannot be taken with
closer to the time of your next dose. Do not double up on your next dose. associated with resistance to Biktarvy. St. John’s wort decreas-
Biktarvy is not recommended for people with CrCl less than 30 mL/min FTC and 3TC. Weight gain can be es Biktarvy levels and should be
or people with severe liver impairment. Biktarvy may be used for people associated with INSTIs and TAF, avoided. Take aluminum- or mag-
with an undetectable viral load and CrCl less than 15 mL/min who are and among INSTIs, bictegravir nesium-containing supplements,
also receiving hemodialysis. and dolutegravir were associ- vitamins, or antacids at least 2
ated with more weight gain than hours after or 6 hours before
elvitegravir/COBI, NNRTIs, and Biktarvy, although iron- and
➤ SEE ALSO DESCOVY, which aching, or tenderness on the right PIs in several studies. In an calcium-containing compounds
is contained in this drug side below the ribs. analysis of 8 randomized trials, can be taken with Biktarvy and
(bictegravir is not available the average weight gain for BIC- a meal. I have seen lots of “low-
separately). n POTENTIAL DRUG INTERACTIONS and DTG-containing regimens level viremia” cured by adjusting
➤ SEE PACKAGE INSERT for more Do not take with rifampin or was 3.5 kg (7.7 lbs.) at 96 weeks. supplements. Don’t take Biktarvy
complete information on poten- dofetilide. Not recommended to It’s important to watch your diet if you are planning to become
tial side effects and interactions. be taken with Cimduo or Temixys, and exercise regardless of what pregnant because of lack of data
Descovy, Emtriva, Epivir-HBV, you are taking, but that can for safety in pregnancy. If you
n POTENTIAL Hepsera, Truvada, Vemlidy, or be especially true with a TAF + are already pregnant and taking
SIDE EFFECTS AND TOXICITY Viread, all for treatment of hepatitis INSTI combo. All INSTIs have Biktarvy, talk with your HIV care
Most common side effects (rarely B, as the emtricitabine and tenofo- the potential for insomnia or, provider about whether it’s advis-
experienced) include headache, vir components of Biktarvy already rarely, worsening of depression able to continue the drug.
nausea, and diarrhea. INSTIs and treat HBV. Biktarvy can be taken at or suicidal ideation, particularly
TAF are associated with weight least two hours before or six hours if there are pre-existing mental ACTIVIST MICHAEL BRODER:
gain. Serum creatinine, estimated after taking laxatives or antacids, health issues. INSTIs have fewer Most people taking
creatinine clearance, urine glucose, sucralfate, oral iron or calcium drug-drug interactions than Biktarvy (approved in 2018) have
and urine protein should be supplements (but either of these most NNRTIs and PIs. A Gilead- no side effects. Concerns have
obtained before initiating Biktarvy two can be used with Biktarvy if sponsored chart review study in emerged about weight gain on
and should be monitored. BIC can taken with food at the same time), 350 persons who were at least INSTI-containing regimens. As
cause a small, reversible increase or buffered medications. Start met- 50 years old who had switched always, your provider should
in serum creatinine within the first formin at lowest dose and titrate to Biktarvy found that 140 drug help you weigh the benefits
few weeks of treatment that does based on tolerability and clini- interactions in 121 people were against the risks.
not affect actual kidney function. cal effect. Monitor for metformin
There have been rare reports of adverse effects. When starting
depression and suicidal ideation or stopping Biktarvy in people on have detectable virus when they
with INSTIs, primarily among metformin, dose adjustment of met- switch to it from another regimen
people with a history of psychiatric formin may be necessary to main- (having experienced virologic failure
illnesses. DHHS guidelines tain optimal glycemic control. Not on their previous regimen). At this
recommend closely monitoring recommended with St. John’s wort. time, there aren’t sufficient data to
people with pre-existing psychiatric Can be taken with Epclusa, Harvoni, support the use of Biktarvy during
conditions. Prior to initiation, Sovaldi, and Vosevi. Tell your pro- pregnancy. Pregnant individuals can
test for hepatitis B virus (HBV). vider or pharmacist about all medi- voluntarily enroll in the Antiretroviral
Severe exacerbations of HBV have cations, herbals, and supplements Pregnancy Registry through their
been reported in people with you are taking or thinking of taking, provider; go to apregistry.com.
co-infection who have discontinued prescribed or not, as there are other
Biktarvy (due to elimination of the drug interactions which are not n MANUFACTURER
emtricitabine and TAF components, listed here. Gilead Sciences, Inc.
which also treat HBV). Monitor liver gilead.com; biktarvy.com
enzymes closely. Initiation of HBV n MORE INFORMATION (800) GILEAD-5 (445–3235)
therapy may be warranted upon New pediatric formulation, Biktarvy
discontinuation of Biktarvy. Call Low Dose, became available n AVERAGE WHOLESALE PRICE
your health care provider right away late last year. Biktarvy is widely $4,300.56/month
if you develop any of the following prescribed because of its efficacy
signs of hepatitis: yellowing of the and safety profile as well as relative
skin or whites of the eyes; dark lack of resistance emerging from
or tea-colored urine; pale-colored use of this treatment in clinical trials.
bowel movements; nausea or Data are accumulating that show
vomiting; loss of appetite; or pain, Biktarvy works for people who
positivelyaware.com/biktarvy | M A R C H + A P R I L 2 0 2 2 21You can also read
