[Viva] Fwd: TreatmentUpdate 233

[shelly tognazzini]

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From: CATIE <mailer at catie.ca>
Date: Thu, Oct 3, 2019 at 9:36 AM
Subject: TreatmentUpdate 233
To: <shetognazzini at gmail.com>


Anti-HIV Agents
Issue 233

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[image: CATIE Treatment Update]
Anti-HIV Agents

Biktarvy begins to get listed on provincial drug formularies
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=fb5d44d222&e=3006f90030>
More provinces are adding Biktarvy to their list of subsidized medicines.

*Dovato (dolutegravir + 3TC) in initial HIV treatment*
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=e0bb7aabde&e=3006f90030>
In August 2019, Dovato (a pill containing dolutegravir + 3TC) was approved
for the initial treatment of HIV in Canada and other high-income countries.
Detailed two-year clinical trial results reveal that dolutegravir + 3TC
continues to show similar effectiveness and safety as standard three-drug
therapy. However, the dual-drug regimen was less powerful among people with
low CD4+ counts.

*Switching to Dovato (dolutegravir + 3TC) from a TAF-based regimen*
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=70cd31bdd8&e=3006f90030>
In addition to being used for the initial treatment of HIV, Dovato may be
considered for regimen simplification. In a phase III clinical trial called
Tango, which has enrolled participants taking a standard regimen that
included TAF (tenofovir alafenamide), some people were switched to a
reduced drug regimen of dolutegravir + 3TC. After 48 weeks on the dual-drug
therapy, researchers found similar rates of effectiveness and safety among
the regimens.

*Some issues to consider with Dovato (dolutegravir + 3TC)*
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=34232d5e2b&e=3006f90030>
Clinical trials for Dovato for the initial treatment of HIV and for a
change to a simpler regimen have found this dual-drug therapy as effective
as standard triple-drug therapy (or, in some cases, four-drug therapy).
However, there are some issues to consider, including for people who have a
low CD4+ count or a high viral load, and for people with chaotic lives who
have difficulty taking medication.

*More dual HIV regimens are coming*
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=225504d9c1&e=3006f90030>
In the early 1990s, HIV treatment for some people consisted of dual-drug
regimens. Such regimens, based on nucleoside analogues, did not confer
benefit for long and were toxic. Today, dual therapy has returned, with
more powerful and safer therapies anchored by integrase inhibitors and
possibly other classes of drugs in the future. The next decade holds the
promise of dual therapy for both initiating HIV treatment and as
maintenance/switch therapy in virally suppressed patients.

*Decreasing the risk of neural tube defects with dolutegravir*
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=6908e4a82d&e=3006f90030>
In 2016 Botswana began a shift from the use of efavirenz-based regimens for
initial HIV treatment to dolutegravir-based ART. Based on data about the
safety of dolutegravir taken at conception or later in pregnancy,
researchers in Botswana found “a potential early signal” for a type of
birth defect called neural tube defects. A subsequent study showed that
dolutegravir-associated neural tube defects began to fall after May 2018.
It is unclear why the risk of neural tube defects appeared in the first
place and why this risk is now decreasing in Botswana.
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