In line with the new needs of HIV-infected patients, the compound single-tablet formulation with less DDI is preferred

For medical professionals only, what are the tangible benefits to patients of drugs with fewer DDIs? AIDS (AIDS), caused by human immunodeficiency virus (HIV), is one of the most serious public health challenges in China and the world.
In recent years, with the application of antiretroviral therapy (ART), AIDS has gradually become a It is a chronic and controllable disease, but it also brings new problems and challenges to disease prevention and treatment
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 Drug-drug interactions (DDIs) between different antiviral drugs and other drugs are one of the growing concerns
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Entering the era of compound single tablet treatment, what impact will DDI have on the treatment of HIV-infected patients? In ART treatment, how should relevant factors be considered and the appropriate drug should be selected? Aging and comorbidities among HIV-infected patients add a new dimension to ART.
With the continuous advancement of ART treatment, especially Bicanoprena (B/F/TAF) containing an integrase inhibitor (INSTI) regimen When the compound single-tablet preparation comes out, the treatment effect of HIV-infected patients is also improving.
The direct impact is that the life expectancy of patients is getting closer and closer to the general population, which is undoubtedly a trend that clinicians are happy to see
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 But at the same time, the rise in life expectancy of HIV-infected people also means that the group of HIV-infected people will gradually move towards aging, and HIV-infected people around the world are complicated by cardiovascular disease, diabetes, kidney function damage, osteoporosis and a series of age groups.
The proportion of related diseases is increasing year by year, and a series of epidemiological investigations carried out in China also reflect a similar situation [1-3]
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 Therefore, HIV-infected patients often need to take other common types of drugs based on their own conditions while receiving ART, and the infected people face a long road to anti-AIDS
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Therefore, when clinicians choose ART regimens, in addition to considering factors such as CD4 cell count, plasma HIV RNA, drug resistance and other factors of the AIDS disease itself, they also need to consider the patient's comorbidity and medication status, and try to choose less DDI, Treatments that do not affect concomitant medications or increase the risk of comorbidities
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 There are very few DDIs, and the B/F/TAF program allows HIV-infected patients to take medication with peace of mind.
In recent years, some authoritative international guidelines for AIDS treatment have also begun to specifically emphasize and pay attention to the DDI issue of ART drugs, such as the 2021 European Clinical AIDS Society (EACS).
Guideline 11.
0 [4] lists all recommended ART regimens and DDIs of commonly used drugs such as antihypertensive drugs, lipid-lowering drugs, and antidepressants, respectively, so as to guide clinicians in convenient medication
.

 Among the ART regimens recommended by the EACS guidelines, the B/F/TAF regimen is the one with less DDI, and is associated with cardiovascular drugs, central nervous system drugs, antidepressants, contraceptives, antiplatelet aggregation and anticoagulant drugs, and antihypertensive drugs.
The DDI of the drug is small, so when the core drug in Bicapronol tablets, bictegravir (BIC), is used in combination with most of the above drugs, there is no need to monitor and adjust the dose (see Table 1 for details)
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 Table 1: BIC-related DDIs listed in EACS guidelines green and yellow do not require monitoring and dose adjustment, and red is prohibited as a compound single-tablet preparation.
Bicoempronol tablets are inherently easy to take, which helps to improve patient compliance and Satisfaction with treatment, while less DDI does not affect patients' treatment of other comorbidities or potential risk factors, and is more conducive to patients' daily medication and long-term treatment
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Combined with the advantages of excellent long-term virological inhibition rate, good bone, kidney, liver and cardiovascular safety, and extremely low risk of drug resistance, BiKempronol tablets have naturally won the favor of a series of domestic and foreign guidelines [4-5 ]
.

 Showing a full range of treatment benefits, the B/F/TAF program enables patients to better resist "AIDS".
The constantly updated clinical research data show that B/F/TAF has no effect on HIV infection in both newly treated and previously treated HIV-infected patients.
It has excellent performance in many aspects, such as academic inhibition and treatment safety, and solid evidence-based medical evidence provides a basis for its widespread use in the treatment of HIV-infected patients
.

 For example, the randomized, double-blind, controlled core clinical phase III studies 1489 and 1490 in newly-treated HIV-infected patients have been updated to 192 weeks (4 years) of follow-up data, and the B/F/TAF regimen treatment group is as high as 99.
2 % of patients were able to achieve virological suppression (HIV-1 RNA <50c/ml, see Figure 1) without treatment-related BIC, emtricitabine (FTC) or tenofovir alafenamide (TAF) The drug resistance mutation achieved 192 weeks 0 drug resistance [6]
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 Figure 1: Virological Suppression at Week 192 of Study 1489 and Study 1490 In terms of safety, the 192-week follow-up data of both studies 1489 and 1490 also showed that the B/F/TAF regimen was well tolerated in the long term , ≤ 2% of patients discontinued due to adverse events, no proximal renal tubular disease or discontinuation related to renal function occurred, and the patients' spine and hip bone mineral density and fasting blood lipids had smaller changes from baseline [7- 8], so there is no need for frequent monitoring of liver, kidney, bone, cardiovascular and other functions during treatment, which at the same time reflects the safety and convenience of Bicoenprena treatment
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 Summary With the aging trend of AIDS patients, whether DDI problems related to ART programs will affect patients' comorbidities and other medical needs has become a high concern in clinical practice
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The B/F/TAF regimen has less DDI, which means less impact on patients, can improve treatment compliance and convenience, combined with potent and durable virological suppression efficacy, further consolidate its treatment preference in ART status
.

 Reference: [1]He N, Ding Y, Li J, et al.
HIV and aging in Mainland China: implications for control and prevention research[J].
Current HIV/AIDS Reports, 2019, 16(6): 439- 447.
[2]Wu PY, Chen MY, Hsieh SM, et al.
Comorbidities among the HIV-infected patients aged 40 years or older in Taiwan[J].
PloS one, 2014, 9(8): e104945.
[3] Zhou Y, Yang Z, Liu M, et al.
Independent Risk Factors for Deaths due to AIDS in Chongqing, China: Does Age Matter?[J].
Frontiers in Medicine, 2021: 1047.
[4]EACS Guidelines version 11.
0, October 2021.
[5]Saag MS, Gandhi RT, Hoy JF, et al.
Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society–USA Panel[J].
JAMA, 2020, 324(16 ): 1651-1669.
[6]Ambas J, et al.
vIAS 2021.
Poster #PEB151[7]Workowski K, et al.
vCROI 2021.
Poster 415.
[8]Collins,Sean (Hindman, Jason).
CROI 2021 Poster 2268.
This information is for medical and scientific purposes only, and the use of this product in any manner inconsistent with the prescribing information approved in your country is not recommended,