A 45-year-old man was diagnosed with HIV-1 (the most common and virulent strain of the virus). He was in the initial stage, and his family’s livelihood depended on him. Dr. prescribed him a once-a-day prescription pill, it is a high-efficacy medicine, a combination of three antiretroviral drugs. There is no dietary restriction; he can take it with or without food.
After a few weeks he developed serious symptoms (side effects) such as deep and short breathlessness, muscle pain and cramping, fatigue, blue hands and feet, nausea, vomiting, and a fast heartbeat.
After noticing symptoms, the doctor immediately held medicine for the patient and started diagnosing the symptom first.
Questions
1.Name all three combined antiretroviral drugs.
2.Which medication did Dr. prescribe to the patient?
The medication prescribed is TLE regimen, which is a combination of Tenofovir, Lamivudine and Efavirenz. Even though fixed-dose combinations like TLE may improve the quality of life with once daily dose, healthcare professionals must stay vigilant for a rare but life threatening side effect - lactic acidosis.
The patient might have developed lactic acidosis because he was given nucleoside reverse transcriptase inhibitors which would inhibit mitochondria and so there will be toxic accumulation of lactic acid in the cells .
The answer is Biktarvy, which is a single-pill medication, a combination of three drugs (Bictegravir, Emtricitabine, and Tenofovir alafenamide), and taken with or without food.
In some cases even on the day of diagnosis, the doctor prescribed Biktarvy.
LTD (Dolutegravir + Tenofovir + Lamivudine) is also a single-pill combined antiretroviral therapy (ART). Also taken on an empty stomach or with food, it shows approximately the same efficacy as Biktarvy, but the barrier to resistance is very high, and there are fewer side effects and better tolerability in the case of Biktarvy as compared to LTD medication.
Biktarvy is a complete, fixed, single-dose medicine. In the case of LTD, there is a customized individual dose adjustment option to reduce the dosage of tenofovir and lamivudine in patients with poor kidney function.
Side effects—Lactic acidosis due to mitochondrial toxicity driven by nucleoside reverse transcriptase inhibitors (NRTIs) in their formula, emtricitabine and tenofovir alafenamide.
Biktarvy is a single-pill HIV medicine taken with or without food and may be started soon after diagnosis. Dolutegravir + Tenofovir + Lamivudine (LTD) is also a one-pill treatment with similar effectiveness. Biktarvy may cause fewer side effects and is easier to tolerate, while LTD can be adjusted for people with kidney problems. Rarely, these medicines may cause lactic acidosis.