Imagine giving a patient the news of an HIV diagnosis. How often does such a diagnosis occur in the U.S.?
Society has a reached a point where HIV is no longer the catastrophe it once was. More than 1.2 million individuals over age 13 are estimated to be living with HIV in the U.S., reports the Centers for Disease Control and Prevention (CDC). As health professionals, it is easy to simply refer patients to specialists, making the disease’s prevalence seem irrelevant, but do you really know how often the diagnosis is given?
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In 2014, the most recent year for which statistics are available, 44,073 people in the U.S. were diagnosed with HIV. So, what has changed in the modern world? The answer is simple; medications are finally bringing HIV under control. However, the medications for HIV (collectively known as HART medications) are different from medications for many other illnesses.
Since community health continues to focus on the importance of early diagnosis and prevention of HIV, understanding newer medications can further strengthen the argument. Furthermore, HART medications are not 15-pill regimens like in the past, and this point alone focuses the conversation on once-daily medications.
Once-Daily Treatment Medications for HIV Are Available.
Advancements in medicine have led to “once-daily” treatment regimens for HIV. These medications are commonly known as “cocktails” or “combo” meds. Patients only need to take one pill, and the risk of missed doses is reduced. This is an important consideration in HIV treatment. Failure to continue taking HIV medications can result in the development of an immunity to the respective drug.
Once-daily HIV medications can have drastically different side effects and adverse reactions. Since some drugs have similar components, the strongest contrast and similarity exists between Stribild and Triumeq, and a careful understanding of both drugs is warranted.
(elvitagravir 150mg/ cobicistat 150mg/ emtricitabine 200mg/ tenofovir disoproxil fumarate 300 mg)
Stribild combines the components of Truvada, Viteka and Tybost into a once-daily pill, reports the drug’s manufacturer, Gilead Sciences, Inc. This medication is physically larger than other HIV meds, about the length of a quarter and the width of a fine-point permanent market. Patients should take Stribild with food to ensure the medication is absorbed properly. Although effective in managing HIV, Stribild does not cure or completely prevent transmission of HIV.
Risks and Considerations in Taking Stribild.
Stribild does carry some risks and considerations, which include the following:
- Antacids should not be taken within two hours of taking Stribild.
- Those with a history of chronic kidney disease or kidney failure should avoid Stribild. If the creatinine clearance of a patient on the medication drops below 50 mL/min, Stribild should be discontinued.
- The drug is not recommended for use in those with impaired or an expected decrease in liver function. For example, those with acute hepatitis B should not begin taking the drug.
As with all once-daily treatments for HIV, Stribild should not be combined with any other HART medication. The overall adverse reactions to this medication remain minimal, but the drug has not been extensively studied in children or pregnant women. Information for other HIV treatment medications for these affected groups may be obtained from community health organizations. Consequently, those who do not have a defined contraindication may be started on this drug to fight HIV.
(abacavir 600mg/ dolutegravir 50mg/ lamivudine 300 mg)
Although Stribild is less than 4-years-old, the newest cocktail is Triumeq, manufactured by ViiV Healthcare. Triumeq is a once-daily pill as well, but it is based on a different class of medications. Unlike Stribild, the backbone of Triumeq is the abacavir component. Unfortunately, this backbone can be extremely dangerous.
A Key Consideration: Allergic Reaction to Abacavir.
Abacavir has been known to cause severe allergic reactions, and these reactions can result in death. However, researchers have identified a gene variation that increases the likelihood of this reaction. For that reason, an abacavir hypersensitivity screening for the HLA-B*5701 gene variation is practically a requirement before taking this medication.
A negative test result implies a hypersensitivity reaction will not occur. In reality, the risk is lower, but a reaction is a possibility. If any symptoms of an allergic reaction occur, such as fever, hives, rash, shallow breathing or severe digestive upset, immediate medical attention is required. Another indicator of a severe reaction to the medication includes “very low blood pressure.” The urgency of recognizing the reaction cannot be understated to providers and patients.
Triumeq may also cause problems with renal and hepatic functioning. One problem, lactic acidosis, may be more likely to occur in certain populations, such as women, obese patients or those on nucleoside analogue medications for an extended period of time. While it is permissible to take Triumeq when diagnosed with hepatitis B, health professionals must monitor patients for signs of decreased hepatic function.
The primary takeaway from the discussion on Triumeq for better community health education on HIV is the emphasis on both HLA-B*5701 screening and monitoring of liver function. Therefore, the use of over-the-counter medications should be monitored concurrently for potential impact on the liver and kidneys.
Triumeq may cause other unpleasant side effects, which include the following:
- Nausea and vomiting.
- Muscle weakness.
Which Medication Is the Better Option?
Knowing the risks of Stribild and Triumeq, it is easy to assume Stribild is the safer option. However, HIV is a retrovirus, meaning it can mutate and become immune to medications with ease. Taking the medication as prescribed is the best means of preventing the development of an immunity. The decision to take Stribild or Triumeq depends on each patient’s viral load (the number of HIV copies in the blood), absolute CD4 count and history of HIV treatment regimens.
Final Thoughts on Triumeq and Stribild for HIV Treatment.
HIV’s decreasing prevalence has led many general health practitioners to successfully treat and manage the virus. However, a general practitioner may not have experience with the newest HART medications. As a result, it is a good idea to at least see a specialist annually to review the status of one’s HIV infection in detail.
Community health often focuses on prevention of HIV, but the conversation needs to include those who are already living with the disease. Understanding the latest about treatment options can encourage affected individuals to start treatment before the disease worsens.