Posts Tagged → #HIVPEP

Two-Drug or a Three-Drug Post-exposure Prophylaxis in Occupational Exposure to HIV

Among occupations, Medical professionals are the ones who are most highly exposed to infections and threats of communicable diseases. Human Immunodeficiency Virus (HIV), being an untreatable virus, holds great risk to medical professionals especially those who work with HIV-infected patients and needles. HIV Post-Exposure Prophylaxis (PEP) is something that can greatly reduce the risk of infection during the course of their work. A review article published in a medical scientific journal, “Clinical Infectious Diseases” in 2004 gathered the published data to correlate the efficacy and toxicity of two drug and three-drug PEP regimen for occupational exposure to HIV.

Most of the available literature is on animal models as there are ethical limitations for clinical trials on humans. In a nutshell, these trials show an earlier start and a 4-week use of PEP is the most effective. Only one case-control study, reported and published in 1994, was conducted on health care professionals which showed that the use of a single antiretroviral drug (zidovudine) decreases the risk of HIV transmission to 79%. It also showed that only 33 out of 698 professionals, receiving monotherapy PEP became seropositive. After this study, the Center for Disease Control and Prevention (CDC) developed empirical PEP treatment guidelines for occupational HIV exposure.

These guidelines suggest the use of at least two drugs for PEP. According to the review there is more usage of a three-drug therapy in both the USA and Europe despite more side effects than a two-drug therapy which unfortunately leads to lesser compliance and early discontinuation usually resulting in PEP failure. However, HIV infected patients show better compliance to therapy with three-drug as compared to people receiving PEP for prevention.

For minor pricks and exposure to aberrations, CDC recommends the use of only a 2-drug regimen of PEP. The aim is to prevent virus from developing the infection in the body which can be achieved by a 2 drug therapy for at least 28 days. For more deep exposure like penetrating wounds, a three-drug therapy is recommended. Interestingly, one study showed that those on a three-drug PEP therapy had more side effects than HIV-infected patients on a three-drug treatment as well as an 8-times higher rate of discontinuation.

The review showed that the efficacy of the three-drug PEP was better than the two-drug PEP, but overall adherence to the treatment was better with two-drug PEP therapy. As mentioned previously, the toxicity was found to be higher with three-drug PEP. Although there is  data on the frequency and percentage of the antiretroviral drug resistance, there is almost no data on the extent of drug resistance to the different types on PEP.

Based on the available data, the authors of the publication made a model for the PEP which showed that without HIV PEP, 300 out of 100,000 HIV-exposed health care professionals will become seropositive. This transmission will come down to 108/100,000 with three-drug PEP therapy. A two-drug PEP will result in transmission to only 105, which are only 3 cases less than the three-drug PEP.

The two-drug PEP, as a whole, has better outcome and lesser toxicity than the three-drug PEP. Therefore, with lower antiretroviral resistance a two-drug PEP is recommended by the review.

Source:

Bassett I V et al Two Drugs or Three? Balancing Efficacy, Toxicity, and Resistance in Postexposure Prophylaxis for Occupational Exposure to HIV. Clinical Infectious Diseases, 2004.

The World of Antiretrovirals

In the 1980’s diagnosis with HIV was a death sentence. In 1995 in the USA, it was the highest cause of death in the age range 25-44 years. Nowadays HIV is a life sentence, but a relatively painless one. Anti-retroviral therapy (ART) has ensured that the virus is kept locked away in the host DNA, never to be seen more in most cases.

From no treatment available in 1983 to more than 40 retroviral inhibitors in 2015, with more in the works, scientists are staying one step ahead of emerging resistance. The death toll from HIV continues to plummet. Anti-retrovirals consist of a wide range of drugs that target different stages of the virus lifecycle.

Stage 1: Invasion

The first thing the virus needs to do to effect a successful infection is get into the cell. This stage is thwarted by the entry inhibitors, notably maraviroc (MVC) and enfuvirtide (T-20).

Maraviroc binds to the host cell receptor that the HIV virus binds to before working its way into the cell. It is not a common treatment. The binding of Maraviroc to the cell can open up a secondary binding site, allowing the HIV to attach regardless. The drug also has liver toxicity issues. It has however been approved by the FDA for human use and is a fallback when other drugs prove ineffective.

Enfuvirtide acts on the virus rather than the host cell, binding to the gp41 protein that HIV uses to attaches to the cell, inactivating it and stopping invasion of the cell before it starts. As with Maraviroc, it is used as a ‘salvage therapy’ rather than the first port of call due to its high cost and the fact it can only be administered as an injection.

Stage 2: Transcription

HIV is a retrovirus, which means that the virus genome is made of RNA rather than DNA. In order to replicate it needs to transcribe the RNA code into the DNA used by mammalian cells for genomic content. Mammalian cells only transcribe DNA to RNA, not the other way around. The protein needed to transform the RNA into DNA has to be provided by the virus. It makes a good place for scientist to target as the fact that it is not a protein seen in humans reduces the risk of side-effects.

The Nucleoside (or Nucleotide) analogue reverse transcriptase inhibitors (NRTI). NRTIs are specialised nucleosides, the building blocks of DNA, lacking the essential hydroxy group on its 3’ end. Lack of this group prevents it from binding to another nucleoside and stops the construct of the DNA strand cold. Without this DNA strand the virus is unable to trick the host cell into replicating viral the viral genome. The NRTIs are the most effective anti-retroviral therapies and include some of the oldest anti-retroviral among their number. Examples include zidovudine (ZDV), abacavir (ABC), lamivudine (3TC), emtricitabine (FTC), and tenofovir (TDF).

Non-nucleoside analogue reverse transcriptase inhibitors (NNRTI). NNTRIs are drugs that target the viral reverse transcriptase directly rather than targeting the process. By binding the viral protein near the active site they change the structure of the active site, so it cannot bind nucleosides and catalyse the formation of DNA from the RNA viral genome. Examples include nevirapine (NVP), efavirenz (EFV), etravirine (ETR) and rilpivirine (RPV).

The virus is not able to change the building blocks of DNA so resistance to NRTIs is uncommon, however, it can change the structure of the reverse transcriptase protein. HIV-2 is naturally resistant to NNRTIs.

Stage 3: Integration

A viral infection that destroys all the cells it is able to infect does not have a long lifespan. To ensure it lives to fight another day, the virus does not destroy all the T-cells in invades. In some instead of taking over the cellular machinery to make thousands of copies with the transcribed DNA, it inserts its own DNA into the host cell genome using a viral protein known as an integrase.

In 2007, the drug raltegravir (RAL) was approved by the FDA. Raltegravir binds in preference to the native substrate, i.e. if there is any raltegravir nearby the integrase will select that before the host genome it is meant to target. In this way, it uses up all the integrase before the virus can insert into the genome. In 2014 two more integrases inhibitors were approved for use, elvitegravir (EVG) and doultegravir (DTG).

Stage 4: Virus production

Once the viral DNA has been transcribed and integrated the virus needs to then make more copies of itself. It does this by tricking the host cell to replicate the viral RNA genome and proteins in preference to its own functions, killing the cell in the process. The viral proteins are made as one long peptide (protein) chain called the gag/pol precursor and this is cut up by a viral protease (enzyme that cuts proteins) to separate the individual proteins into their active form.

The protease inhibitor antiretroviral drugs target this stage of the virus lifecycle, preventing the protease activity and activation of viral proteins. Protease inhibitors include lopinavir (LPV), indinavir (IDV), nelfinavir (NFV), amprenavir (APV) and ritonavir (RTV). Due to high mutation rates of the viral genome and high tolerance for mutation in the viral protease, this category of drugs suffers the most from emerging resistance.

The drugs are used as combinations to target multiple stages in the viral cycle and reduce the incidence of resistance. They are used in combination to target the virus at all stages of infection, commonly 2 NRTIs in combination with either a NNRTI, a protease inhibitor or an integrase inhibitor.

Different combinations are preferred for different situations. One of the earliest NRTIs Zidovudine (first approved 1989) has been shown to be incredibly effective in reducing the viral load in pregnant women to prevent transmission to the baby during birth. Use of Zidovudine has reduced transmission of HIV to the baby during birth from 30% of cases down to 2%.

The pre-exposure prophylaxis (PrEP), taken by those at high risk of encountering HIV is a combination of tenofovir and emtricitabine marketed as a one dose combination therapy under the name of Truvada® by Gilead Sciences. This drug has been shown to be safe for people ages 12 years and older and in various studies have shown that a daily dose reduces the risk of contracting HIV by up to 75% in high-risk individuals. Truvada is also recommended for post-exposure prophylaxis (PEP) though this can vary depending on doctor, socio-economic considerations and regional resistance, other combination therapies can be equally effective.

The first one dose combination therapy was developed by GlaxoSmithKline in 2007. Called Combivir® it contained a combination of lamivudine (3TC) + zidovudine (ZDV). As of February this year, eleven other single dose combination therapies had become available. This may seem a small breakthrough but it increases the likelihood that people will continue to take their medications and stay virus free, reducing the costs to the healthcare system, increasing peoples work life and reducing the risk of spreading via sexual contact. These miracle pills did what antibiotics did in the 1950’s, turned a killer into a mere inconvenience. With ongoing research this inconvenience lessens each year and with the blessing of hindsight we know how to reduce the threat of resistance. With good management, extensive education and ongoing research, AIDS may one day join smallpox and polio as a disease of interest only to historians.

HIV/SIV PEP in Non Human Primates: a Meta-analysis

Animals have long been the most faithful friends of humans but what is more interesting to know is that they have been a model for scientific experimentation which helps humans to make better medication and cure. A recently published meta-analysis report by the team of Irvine C. in the journal “Clinical Infectious Diseases”, the authors have admirably gathered the data published since May 2004 on the efficacy of HIV Post-exposure Prophylaxis (PEP).

The efficacy of PEP in humans was first published in 1997 in a case report. As there are ethical limitations in human subjects, animal models play a vital role in the clinical trials and research. Therefore, there are more studies on animal models and this analysis was done one data published on nonhuman primates.

The meta-analysis was done on more than 2000 papers published in medical web portals like Pubmed, Web of Science and Embase on nonhuman primates. Out of the 2517 papers and abstracts searched and found on HIV PEP, 2238 papers were excluded. 247 were duplicates which were also excluded. Out of the 40 remaining full articles, only 25 were finally selected because only these 25 papers had at least one animal which converted from being uninfected to seropositive and was given at least one antiretroviral medication. To have a more accurate analysis, the data was extracted by two different authors of the paper, simultaneously. The selection criteria were:

  • publication which were from peer reviewed journals
  • had controls
  • randomization to treatment
  • sample size was calculated
  • statement of compliance and statement related to conflicts of interests.

This meta-analysis was conducted according to protocol following the requirements set by the Preferred Reporting Items for Systemic Reviews and Meta-analysis (PRISMA).

Most of the animals which were studied in these reports were rhesus macaques or cynomolgus monkeys. Out of the total 408 primates studied, 180 were the infected animals versus 103 controls. The simian immunodeficiency virus (SIV) or Human Immunodeficiency virus (HIV) were administered to animals primarily via an intravenous route while the PEP drug/drugs were given subcutaneously. Interestingly, the animals which were on PEP were at an 89% lower risk of becoming seropositive.

The report also shows that the earlier the PEP is started the lower the rate of seroconversion. While there was no significant difference in the type of the antiretroviral medication given, there was a lower percentage of the seroconversion in the animals treated with tenofovir when compared with other drugs.

Another thing of interest with the figures was that older studies showed less efficacy of the drugs while more recent studies favored PEP.

After the authors collected and reviewed the data from previously reported papers, they emphasized that there is a need for better publications and research on the efficacy of PEP in nonhuman primates.

This meta-analysis, as a final point, emphasizes on the efficaciousness of earlier start in the application of antiretroviral PEP medications after exposure to HIV.

Source:

Irvine C et al. Efficacy of HIV Postexposure Prophylaxis: Systemic Review and Meta-analysis of Nonhuman Primate Studies. Clinical Infectious Diseases. 2015

HIV prevention: The Emerging Prevention Regimen from Post-exposure to Pre-exposure Prophylaxis

Like vaccinations for life-threatening diseases such as Hepatitis B and Tetanus, the HIV virus could be tackled more efficiently with the presence of a vaccination for this disease. Researchers have been successful in developing a pre-exposure prophylaxis (PrEP) for HIV which is now a leading development towards finally creating a vaccine. Pre-exposure prophylaxis is a combined treatment for the HIV retrovirus that is efficient in protecting people exposed to HIV from developing an infection. This information was very recently reported in Clinical Infectious Diseases, a scientific journal dedicated to infectious diseases.

HIV post-exposure prophylaxis (PEP) which has been in use for a long time, is given to individuals within 72 hours of an exposure to HIV. PEP is a 28-day medication that is a combination of 2-3 antiretroviral drugs. Studies have shown that patients receiving PEP are still at a higher risk of acquiring HIV. People who have a continuous exposure to HIV like injection drug users and people having multiple sexual partners are recommended to use PrEP. PrEP users are reported to have a lower risk of acquiring HIV when compared to PEP. It is, however, highly recommended to avoid the risk of exposure altogether.

The regimen for the PrEP is tenofovir-emtricitabine. This is the only combination approved by the FDA, USA, for PrEP at the moment. It is given either daily or intermittently for a longer period of time, unlike PEP.

People who have already been administering PEP and have a seronegative profile for HIV retrovirus are candidates for PrEP. According to CDC PEP guidelines, a person who has been exposed and administered with PEP can only be considered infection-free after a six-month HIV testing protocol. These candidates who have had PEP and are seronegative will benefit best with PrEP. People who continue to have high-risk exposure to HIV should be started with PrEP earlier than the 4-6 months profile for HIV.

More recently, the US Public Health Service guidelines suggest that if the HIV profile is negative in the preceding 4 weeks and the person is not having any signs and symptoms for HIV he/she can be started on PrEP.

One interesting question addressed by the report is who will be prescribing PrEP to patients. As there is no consensus to date for the specific position which should prescribe PrEP, it is currently prescribed by emergency care departments, the primary physicians and of course by HIV specialists treating the disease.

Although the side effects of PrEP and PEP are not very debilitating, PrEP should be administered with care in patients with bone diseases and renal insufficiency. The use of the tenofovir-emtricitabine combination is known to cause osteopenia, a condition in which bone mass decreases. Patients infected with Hepatitis B should be monitored closely for fulminant acute hepatic failure due to PrEP.

With PrEP, a 3-6 month screening for STI is recommended, especially for people living a high-risk sexual lifestyle.

Source:

Jain et al. The Transition From Postexposure Prophylaxis to Preexposure Prophylaxis: As Emerging Opportunity for Biobehavioural HIV Prevention. CID, 2015.

HIV PEP – A Ray of Hope

The Human Immunodeficiency Virus known as HIV attacks a person’s immune system making them susceptible to infections like tuberculosis, opportunistic infections and even tumours. These are diseases that would normally not affect people with a strong immune system.

Although studies show that there is no cure for HIV, there are drugs available that can slow down the course of the disease and may help extend the life expectancy of a person infected by it.

The HIV pandemic is widespread in regions like Asia and Africa. The last five years have seen a 277% rise in HIV cases in the Philippines alone. Over 400 HIV positive cases were reported in 2007, in the Philippines. This figure rose to a staggering 2,400 cases in the year 2011. Representatives from the United Nation’s Program on HIV-AIDS in Manila, paint a gloomy picture stating that the Philippines is unlikely to meet the sixth Millennium Development Goal i.e. the goal set for reduction of HIV/AIDS.

In Africa, war-ravaged Uganda is also being crushed by the weight of HIV. Northern Uganda reportedly has the highest prevalence of HIV nationwide. A ballpark figure of 100,000 children live with HIV/AIDS in Uganda and at least half of these children reside in the Gulu district of Northern Uganda. Being the economic capital of Northern Uganda, Gulu has its own portfolio of challenges including poverty, child abuse and other health concerns.

Efforts are being made by organizations such as Opportunities Industrialization Centers (OIC) International’s Health, Nutrition & HIV/AIDS programs which educate communities regarding health issues and also provide palliative care to ensure that individuals and communities are equipped with knowledge to lead healthy lives.

Advancements in medical science have yielded two types of drugs that help counter HIV namely Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP). Truvada is a well-known antiretroviral drug. Truvada is a combination therapy because it has 2 medicines in one pill (emtricitabine and tenofovir disoproxil fumarate). Truvada is always used with other anti-HIV medicines to treat HIV-1 infection because Truvada alone is not a complete treatment. Truvada is a Pre-Exposure Prophylaxis (PrEP) drug which must be taken daily to block the transmission of HIV.

Post Exposure Prophylaxis (PEP), on the other hand is a line of HIV medication normally taken within the first 72 hours after a person is possibly exposed to the virus. PEP drugs help prevent the virus from spreading within the body. Health care workers, who have been exposed to the virus while taking care of an HIV+ patient and those that have engaged in sexual intercourse with a person with HIV need to be treated with PEP.

While medical science progresses to counter HIV anti-social elements are in play to further spread the virus and create new challenges for those working to help obliterate the deadly curse. A recent study in the US has found that HIV positive patients, faced with dire economic circumstances, are selling their HIV medications to HIV-negative people, who are using them as a preventative drug against contracting the virus. The motivating factors behind the rise of this new black market and its implications on the current status of HIV are discussed below.

Dr. Steven Kurtz from the Center for Applied Research on Substance Use and Health Disparities in Coral Gables, Florida, recently presented his research at the Conference of the Association for the Social Sciences and Humanities (ASSHH) on HIV in Stellenbosch, South Africa. ASSHH is a well reputed international membership organization geared towards promoting and supporting critically informed and theoretically engaged social science and humanities research on HIV/AIDS.

147 gay men were recruited by Doctor Steven Kurtz. These people were regular drug abusers resorting to drugs like cocaine, crack or heroin. National AIDS Manual AIDSMAP (NAM AIDSMAP) a London-based non-profit geared towards disseminating information pertaining to AIDS. NAM AIDSMAP reported that in order to gain a better understanding of the factors that caused people to trade/sell antiretroviral drugs, Kurtz deliberately over-recruited individuals that were engaged in such activities.

The study conducted by Kurtz found that people faced with dire financial situations were prime perpetrators of the aforementioned activities.

The study also found that the average income of men who sold their antiretroviral drugs, was likely to be under $1000 per month. These men were more likely to have traded sex for money or drugs and were dependent on drugs as well.

Interestingly, the study proved that there was no correlation between the trade of antiretroviral medication and the age, race or level of education of the perpetrators.

Furthermore, it was found that men who had sold their HIV treatment also had low adherence to the antiretroviral treatment. (Adherence in medical terms refers to how easily a patient can take the drugs without medical supervision). Lower adherence means most patients fail to continue/complete a drug regimen.

The study brought to light multiple factors that motivated the trade/sale of HIV medications. It reported that a high proportion of men (74%) sold their medication to purchase recreational drugs or alcohol. While 23% of men wanted to cover their living expenses. A few men had leftover medication or wanted to help someone in need.

Kurtz’s study also brought to light an alarming finding; there was a prevailing misconception amongst the men about the purpose of Pre-Exposure Prophylaxis (PrEP). They confused PrEP with Post Exposure Prophylaxis (PEP). This general misconception regarding has serious implications regarding the prevalence of HIV and its treatment. There is a dire need to carry out a mass public awareness campaign to inform people about the difference between PrEP and PEP.

Despite the challenges, PrEP and PEP are proving to be life saving and have helped counter the negative effects of the deadly virus. Uganda experienced a recent case where PEP medications have actually helped save the life of a 6-year-old boy. This boy was exposed to the disease after being sexually abused by a member of his community. He is in good health but is continuously monitored by medical professionals.

PrEP and PEP have made it possible to stem the tide of rising HIV infections across the globe. With improved education and dissemination of these drugs, the fight against the scourge of HIV is a battle that can be won.

Ground-breaking New Medication for HIV PEP Treatment

HIV PEP NEWS

A study was conducted in two Australian cities namely Melbourne and Sydney to determine the effectiveness of a new drug for the treatment of HIV. A small sample group of 100 healthy non-HIV infected gay men who were eligible for HIV PEP (Post-exposure Prophylaxis) were part of the study.

Post-exposure Prophylaxis (PEP) is a medical term which refers to the use of anti-HIV drugs that can be consumed immediately after one has been exposed to HIV while Pre-exposure Prophylaxis (PEP) refers to treatment that is given in a situation where HIV infection seems possible and in this instance acts as a preventative measure. PEP drugs help prevent the virus from spreading into the body. People in need of PEP drugs include health care workers, who have been exposed to the virus while taking care of an HIV+ patient and those who have engaged in sexual intercourse with a person with HIV. Efforts are being made to increase access to PEP drugs to prevent the devastating effects of HIV on the global population.

Currently, most PEP regimens involve the use of three drugs that patients are required to take twice or sometimes three times a day. However, the painful side effects make it difficult for patients to complete the course of medication without medical supervision. These regimens are therefore not highly effective in preventing the spread of HIV in the patient’s blood.

Efforts are being made to alter PEP drugs so that people can successfully complete the drug regimen with little or no adverse effects. This will dramatically change the way HIV is perceived by people. It will no longer be a deadly virus, with no hopes for survival, but rather an illness which patients can fight through. The small sample group study proved to be a step closer towards achieving this goal.

The men who participated in the study were given a single tablet daily, consisting of the following drugs: Emtricitabine 200mg; Rilpivirine 25mg; and Tenofovir disoproxil fumarate 300mg.

These drugs are commonly referred to as Reverse Transcriptase Inhibitors (RTI) in medical terms. They are rapidly absorbed into the body before HIV spreads into the patient’s blood. Rapid absorption of a drug also plays a key role in its effectiveness. The fact that these drugs are rapidly absorbed into the body show that the drug regimen is highly effective. The group of men received treatment for 28 days. Over the next 12 weeks the participants were required to return for 7 follow-up study visits. During these study visits their blood samples were taken and the drug dosage re-evaluated. The purpose was to determine if any of the participants discontinued the drug regimen before the trial period of 28 days and also if any of the participants tested positive for HIV by the end of the 12 week trial.

One of the key measures of success of a drug regimen is how easily patients can take the drugs without medical supervision. Most people discontinue taking drugs because of the discomfort caused by the side-effects of the drug. In short the success rate of current PEP regimens is very low as people fail to continue drug intake throughout the course of the prescription.

In this study, 92 out of 100 participants completed the drug regimen. Amongst the 92 participants, 98.5% reported that they followed the drug regimen unsupervised. 78 participants returned their pill bottles at the end of the 28-day period and 98.6% of these had successfully completed the drug regimen. Overall 88 of the 100 men experienced negative side effects which included fatigue and nausea. Four participants experienced severe but not life-threatening effects from the drugs.

To verify the accuracy of the drugs, blood samples of 41 participants were tested within two days of the last dose at the end of the 4th week. All participants were reported to have high levels of drug concentration in their blood thus the drug regimen was successfully followed by the participants.

Although this was a small-scale study which does not provide substantial evidence regarding the effectiveness of the new PEP regimen, a promising sign is that none of the 70 men who attended the final follow-up visit tested positive for HIV by the end of the 12 week drug trial. The results from this small scale study look promote the need for a large-scale study to be conducted, involving core groups and control groups, to obtain statistically significant results. Results from a large-scale study can then be used to change the current PEP drug regimens that are in place.

A study was conducted in two Australian cities namely Melbourne and Sydney to determine the effectiveness of a new drug for the treatment of HIV. A small sample group of 100 healthy non-HIV infected gay men who were eligible for PEP (Pre-exposure Prophylaxis) were part of the study.

Post-exposure Prophylaxis (PEP) is a medical term which refers to the use of anti-HIV drugs that can be consumed immediately after one has been exposed to HIV while Pre-exposure Prophylaxis (PEP) refers to treatment that is given in a situation where HIV infection seems possible and in this instance acts as a preventative measure. PEP drugs help prevent the virus from spreading into the body. People in need of PEP drugs include health care workers, who have been exposed to the virus while taking care of an HIV+ patient and those who have engaged in sexual intercourse with a person with HIV. Efforts are being made to increase access to PEP drugs to prevent the devastating effects of HIV on the global population.

Currently, most PEP regimens involve the use of three drugs that patients are required to take twice or sometimes three times a day. However, the painful side effects make it difficult for patients to complete the course of medication without medical supervision. These regimens are therefore not highly effective in preventing the spread of HIV in the patient’s blood.

Efforts are being made to alter PEP drugs so that people can successfully complete the drug regimen with little or no adverse effects. This will dramatically change the way HIV is perceived by people. It will no longer be a deadly virus, with no hopes for survival, but rather an illness which patients can fight through. The small sample group study proved to be a step closer towards achieving this goal.

The men who participated in the study were given a single tablet daily, consisting of the following drugs: Emtricitabine 200mg; Rilpivirine 25mg; and Tenofovir disoproxil fumarate 300mg.

These drugs are commonly referred to as Reverse Transcriptase Inhibitors (RTI) in medical terms. They are rapidly absorbed into the body before HIV spreads into the patient’s blood. Rapid absorption of a drug also plays a key role in its effectiveness. The fact that these drugs are rapidly absorbed into the body show that the drug regimen is highly effective. The group of men received treatment for 28 days. Over the next 12 weeks the participants were required to return for 7 follow-up study visits. During these study visits their blood samples were taken and the drug dosage re-evaluated. The purpose was to determine if any of the participants discontinued the drug regimen before the trial period of 28 days and also if any of the participants tested positive for HIV by the end of the 12 week trial.

One of the key measures of success of a drug regimen is how easily patients can take the drugs without medical supervision. Most people discontinue taking drugs because of the discomfort caused by the side-effects of the drug. In short the success rate of current PEP regimens is very low as people fail to continue drug intake throughout the course of the prescription.

In this study 92 out of 100 participants completed the drug regimen. Amongst the 92 participants 98.5% reported that they followed the drug regimen unsupervised. 78 participants returned their pill bottles at the end of the 28-day period and 98.6% of these had successfully completed the drug regimen. Overall 88 of the 100 men experienced negative side effects which included fatigue and nausea. Four participants experienced severe but not life-threatening effects from the drugs.

To verify the accuracy of the drugs, blood samples of 41 participants were tested within two days of the last dose at the end of the 4th week. All participants were reported to have high levels of drug concentration in their blood thus the drug regimen was successfully followed by the participants.

Although this was a small scale study which does not provide substantial evidence regarding the effectiveness of the new PEP regimen, a promising sign is that none of the 70 men who attended the final follow up visit tested positive for HIV by the end of the 12 week drug trial. The results from this small scale study look promote the need for a large scale study to be conducted, involving core groups and control groups, to obtain statistically significant results. Results from a large scale study can then be used to change the current PEP drug regimens that are in place.

Original article: http://cid.oxfordjournals.org/content/early/2015/06/28/cid.civ511

 

Exposed to HIV? It’s Not Too Late!

Of all the letters in the English language, few are feared as much as the simple combination of H.I.V. Once you’re infected, the impact on your health and on your family can be devastating. As careful as you may be, there are still scenarios which can result in exposure to HIV. Instead of worrying and running the risk of serious health consequences, take steps to protect yourself and your loved ones from the effects of this virus. One way to conquer an HIV exposure is to use PEP.

What is it?

PEP stands for Post-Exposure Prophylaxis, which simply means a treatment that you begin right away after your exposure event. Your goal is to keep from being permanently infected with HIV. This kind of antiretroviral therapy often comes to the aid of healthcare professionals, who face exposure scenarios in the course of their work.

How does it work?

Essentially, the PEP medication creates problems for HIV, preventing the virus from replicating, or copying itself, as it normally would. Without the ability to create HIV copies, the virus cannot spread throughout the body. In a best-case scenario, the spread is contained and infection is prevented.

If you suspect or know that you were exposed to HIV, act now. Don’t wait to be sure. The PEP treatment has a 72-hour window of efficacy, and the sooner you get started on it, the better. The longer you wait, the more time HIV has to copy itself and spread.

Seeking Medical Help

Sometimes, people who have experienced an exposure event are anxious about losing their privacy if they seek help. When you choose an STD clinic in Singapore that provides PEP treatment, rest assured that your personal affairs will be respected and kept private. While doctors and nurses may need to ask you a few pertinent questions, your private life remains secure and undisclosed to anyone else.

How Well Does It Work?

Keep in mind that your level of risk increases depending on the type of exposure involved in your scenario. Certain types of intercourse with an infected partner carry more risk of infection. Sharing needles with an HIV-positive individual is a high-risk situation as well. On the other hand, coming into contact with an infected person’s tears or sweat does not generally result in transmission of HIV.

The good news is that PEP is highly effective in decreasing the possibility of HIV infection. Some reports quote a success rate of up to 81%. Once you and your doctor evaluate the situation, including all benefits and risks, you can begin your PEP treatment, which lasts about 28 days. Be sure to follow up with your STD clinic in Singapore so that the medical professionals there can continue to assess your progress, screen your body for infection, and monitor any potential side effects. Usually, the side effects for PEP are no worse than a little occasional nausea– easy to put up with when you consider the far more serious effects of HIV itself.

Keep in mind that a round of PEP is a one-time solution for an unusual scenario. If you expect to be routinely exposed to HIV, speak with a doctor about preventative measures that can lower your risk for contracting the virus. With prompt action and the right medical advice, give yourself the best possible chance of overcoming an HIV exposure.

New York State Department of Health AIDS Institute recently updated their HIV PEP guidelines

The New York State Department of Health AIDS Institute (NYSDHAI) recently tasked their Medical Care Criteria Committee (MCCC) to update their HIV PEP (Post-exposure Prophylaxis) guidelines. PEP refers to the treatment required and administered after exposure to HIV – a sexually transmitted disease (STD). This exposure is categorised as resulting from sexual assault, occupational exposure, and non-occupational exposure.

In 2012, the recommended medications for post-exposure treatment was the use of tenofovir [Viread®] with emtricitabine [Emtriva®] (or lamivudine [Epivir®]) and raltegravir [Isentress®] – due mainly to the higher rate of completion of the shorter 28-day course of treatment. In 2014, however, dolutegravir [Tivicay®] was added as an alternative to raltegravir [Isentress®]. Dolutegravir is an approved antiretroviral drug designed to block the action of the virus. This change was initiated to further improve the rate of completion of the course of medication based on the side-effects and dosage requirements of dolutegravir [Tivicay®] which have displayed improved tolerability.

The MCCC reported that the efficacy of the above mentioned medications may be compromised when taken alongside aluminium, calcium, iron, or magnesium. Being mindful of the presence of these minerals in food and over the counter antacids was particularly emphasised. As such it was stated that antacids should be taken a minimum of 2 hours before and 6 hours after the medication to receive the maximum benefits of the drugs.

Due to the 6 week window period during which the virus can spread undetected, the committee expressed the need to perform a laboratory blood test (HIV RNA test) even if the patient tests negative during the initial screening test. A newer fourth-generation HIV test was suggested for a more accurate result and the importance of all patients being tested was emphasised.

The recommendations stated that PEP must, as a matter of urgency, begin within 2 hours after exposure while awaiting results of the patient’s baseline tests. Baseline testing refers to the initial tests conducted and includes an immune function test (CD4 count); HIV replication test (viral load); kidney, liver, cholesterol, and blood cell tests; and tests for accompanying viruses or diseases. Baseline testing is required even in cases where PEP treatment is declined.

It was further recommended that patients receive access to psychological counselling and support in order to improve their adherence to guidelines and provide the necessary framework for the completion of treatment.

The committee later updated their recommendations to include further HIV testing at 4 weeks and 12 weeks after exposure and added that routine testing at 6 months is unnecessary in the event that the 12 week test yields a negative result for the presence of HIV. It was clarified that pre-exposure treatment should be explained and made available to individuals who display high-risk sexual activity in the case of non-occupational exposure.

In a public announcement in April 2015, the Governor of New York revealed a detailed plan to reduce new HIV infections. The Blueprint to End the AIDS Epidemic outlines the plan which requires changes to regulation, and a critical look at the state of existing medical infrastructure in order for implementation to be successful.

The uniting feature of similarity between the Governor’s announcement and the Committee’s recommendations was the emphasis on promoting education among both medical personnel and the general public. Numerous campaigns have been launched to this end including the distribution of resources to the relevant clinics and a written inventory of the resources available. The underlying factors for success in reducing HIV infections remains in the availability of resources, education, and expenses.