&lt;p&gt;Condom broke in Thailand &lt;span style=&quot;color: #ff0000;&quot;&gt;|&lt;/span&gt; Emergency PEP&amp;nbsp;&lt;/p&gt;
&lt;h1&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;Boston-study-finds-Biktarvy-useful-for-HIV-post-exposure-prophylaxis-PEP&lt;/strong&gt;&lt;/span&gt;&lt;/h1&gt;
&lt;hr /&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;written FEBRUARY 24, 2022. Last update 3 July 2024&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;Order Kocitaf - Dolutegravir, Emtricitabine &amp;amp; Tenofovir Alafenamide HIV Treatment Medication Online Now. Please&amp;nbsp;&lt;/strong&gt;&lt;/span&gt;&lt;strong&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;email us at&lt;/span&gt;&amp;nbsp;&lt;a href=&quot;mailto:info.silom@pulse-clinic.com&quot;&gt;info.bkk@pulse-clinic.com&lt;/a&gt;&amp;nbsp;&lt;span style=&quot;color: #99ccff;&quot;&gt;or have a chat with us on your preferred platform&amp;nbsp;&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&amp;nbsp;&lt;/p&gt;
&lt;p style=&quot;text-indent: 0px; margin: 0px; text-align: center;&quot;&gt;&lt;strong&gt;&amp;nbsp;&lt;a href=&quot;https://wa.me/66842262569&quot;&gt;&lt;img src=&quot;https://cms.pulse-clinic.com/Files/WhatsApp.png&quot; width=&quot;48&quot; height=&quot;82&quot; /&gt; &lt;span class=&quot;w-30 inline-block px-2 md:px-4 mt-3&quot;&gt; +66-84-226-2569&amp;nbsp;&lt;/span&gt;&lt;/a&gt;&lt;a href=&quot;https://line.me/ti/p/~@442yeswp&quot;&gt;&lt;img src=&quot;https://cms.pulse-clinic.com/Files/line-logo.png&quot; width=&quot;50&quot; height=&quot;85&quot; /&gt; &lt;span class=&quot;w-30 inline-block px-2 mt-3&quot;&gt; @442yeswp&amp;nbsp;&lt;/span&gt;&lt;/a&gt;&lt;a href=&quot;weixin://dl/chat?pulseclinic&quot;&gt; &lt;img src=&quot;https://cms.pulse-clinic.com/Files/WeChat_App_Icon.png&quot; width=&quot;50&quot; height=&quot;85&quot; /&gt; &lt;span class=&quot;w-30 inline-block px-2 mt-3&quot;&gt; PulseClinic&lt;/span&gt;&lt;/a&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;Some HIV drugs taken within 72 hours of a potential exposure reduce the risk of infection&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;Researchers in Boston tested the HIV medication Biktarvy as post-exposure prophylaxis (PEP)&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;The study found Biktarvy was well tolerated as PEP with no HIV transmissions&lt;/span&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;HIV post-exposure prophylaxis (PEP) is an important part of several HIV prevention options. Studies with monkeys have found that a combination of antiviral drugs reduces the risk of infection with simian immunodeficiency virus (SIV) if given within 72 hours of exposure to this virus. SIV is closely related to HIV. Guidelines for PEP in people recommend that PEP be initiated as soon as possible after potential exposure to HIV, to a maximum of 72 hours.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;There have not been large randomized controlled trials of different regimens for PEP. Instead, researchers opt for non-randomized studies.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #ff99cc;&quot; xml:lang=&quot;EN-US&quot;&gt;In Boston&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Fenway Health is a long-standing clinic and research centre serving the LGBT community in Boston. Researchers at the centre conducted a study of PEP using a pill called Biktarvy. This pill is taken once daily and contains three medications:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;bictegravir &amp;ndash; 50 mg&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;TAF (tenofovir alafenamide) &amp;ndash; 25 mg&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;FTC (emtricitabine) &amp;ndash; 200 mg&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Biktarvy is widely used in Canada and other high-income countries as a treatment for HIV. It is highly effective and generally well tolerated.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Researchers in Boston enrolled 52 adults who had very recent exposure to HIV and who sought PEP. All participants were briefly interviewed by a doctor or nurse and underwent an HIV rapid test. The rapid test would have screened for current HIV infection by detecting antibodies due to an infection that occurred much earlier than in the past 72 hours. (This is because the immune system would not have had time to produce antibodies if it had been exposed to HIV in the past 72 hours.) People who tested positive with the rapid test would have been swiftly referred for HIV care.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Participants who were HIV negative were offered a supply of Biktarvy, taken for 28 consecutive days.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;All but one participant completed the study. Testing up to two months after participants first entered the study found that all were HIV negative. Side effects from Biktarvy were generally mild and not common.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;The researchers reviewed other data from what they called &amp;ldquo;historical&amp;rdquo; studies of PEP regimens and made comparisons with the current study. They concluded that Biktarvy was better tolerated than older PEP regimens.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #ff99cc;&quot; xml:lang=&quot;EN-US&quot;&gt;Study details&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Researchers recruited participants who may have been exposed to HIV through condomless intercourse. Participants were referred through the following means:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;primary care providers&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;a hotline in an HIV treatment and prevention clinic&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;self-referrals after an online and in-person community educational campaign&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;At the initial study visit, blood samples were drawn for additional HIV tests, screening for hepatitis B virus (HBV) infection, and to assess the health of the liver and kidneys. PEP was provided in advance of receiving the results of those blood tests. People who tested negative for HBV were offered vaccination against this virus.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Participants who developed any bothersome side effects were encouraged to contact study staff to discuss them. Participants returned to the clinic two weeks after their initial visit and again four weeks after the initial visit. Three months after first visiting the clinic, participants were offered HIV testing.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;At the end of the study, researchers compared data from other studies on PEP using regimens such as the following:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;AZT + a protease inhibitor&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;raltegravir (Isentress) + TDF + FTC&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Genvoya &amp;ndash; a pill containing elvitegravir + cobicistat + TDF + FTC&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Participants entered the study between August 2018 and March 2020.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;The average profile of participants was as follows:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;age &amp;ndash; 37 years (range: 21 to 71 years)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;49 men, 2 women and 1 transgender man; most men were gay or bisexual&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;major ethno-racial groups: White &amp;ndash; 77%; multiracial &amp;ndash; 12%; Hispanic &amp;ndash; 12% (percentages do not total 100 due to overlap)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;56% of participants disclosed more than one recent potential exposure to HIV&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #ff99cc;&quot; xml:lang=&quot;EN-US&quot;&gt;Side effects&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Common side effects were as follows:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;nausea or vomiting &amp;ndash; 15%&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;fatigue &amp;ndash; 10%&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;diarrhea or loose stools &amp;ndash; 8%&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;These symptoms were usually mild and temporary. However, one person left the study prematurely because of excessive fatigue.&lt;/span&gt;&lt;/p&gt;
&lt;h3&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Completed the 28-day course of PEP&lt;/span&gt;&lt;/h3&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;According to the researchers, 90% of participants completed the 28-day course of PEP. The remaining 10% of participants stopped contact with the clinic.&lt;/span&gt;&lt;/p&gt;
&lt;h3&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Bear in mind&lt;/span&gt;&lt;/h3&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;The results of the present study are encouraging. Hopefully, a larger study with a more diverse population will confirm the findings. The researchers also noted that other studies have found that the following combinations are safe and effective for HIV PEP:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;dolutegravir (Tivicay) with TDF + 3TC&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;dolutegravir with TDF + FTC&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;However, they also noted that such regimens would involve taking two pills daily.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Note that PEP is meant as an emergency measure. For people with ongoing exposures to HIV, discussion with a healthcare provider about options to minimize the risk of HIV infection, including the use of HIV pre-exposure prophylaxis (PrEP), is a prudent course of action.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #ff99cc;&quot; xml:lang=&quot;EN-US&quot;&gt;Biktarvy blister packaging approved in Canada&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;In other developments, Health Canada has approved blister packaging for Biktarvy. This can make it easier for patients to keep track of doses that they have taken.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;&lt;em&gt;&amp;mdash;Sean R. Hosein&lt;/em&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;Resources&lt;/span&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;a href=&quot;https://www.catie.ca/hiv-testing-technologies&quot;&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;HIV testing technologies&lt;/span&gt;&lt;/a&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;&amp;nbsp;-&amp;nbsp;&lt;em&gt;CATIE&lt;/em&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;a href=&quot;https://www.catie.ca/client-publication/pep-preventing-hiv-after-a-potential-exposure&quot;&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;PEP: Preventing HIV after a potential exposure&lt;/span&gt;&lt;/a&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;&amp;nbsp;&amp;ndash;&amp;nbsp;&lt;em&gt;CATIE&lt;/em&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;a href=&quot;https://www.catie.ca/client-publication/prep-q-a&quot;&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;PrEP Q&amp;amp;A&lt;/span&gt;&lt;/a&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;&amp;nbsp;&amp;ndash;&amp;nbsp;&lt;em&gt;CATIE&lt;/em&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;a href=&quot;https://www.catie.ca/catie-news/a-novel-hiv-prevention-approach-called-pip-in-cases-with-infrequent-exposure-to-hiv&quot;&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;A novel HIV prevention approach called PIP in cases with infrequent exposure to HIV&lt;/span&gt;&lt;/a&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;&amp;nbsp;&amp;ndash;&amp;nbsp;&lt;em&gt;CATIE News&lt;/em&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;a href=&quot;https://www.cmaj.ca/content/189/47/E1448&quot;&gt;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis&lt;/span&gt;&lt;/a&gt;&amp;nbsp;&lt;span lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot;&gt;&amp;ndash;&amp;nbsp;&lt;/span&gt;&lt;em&gt;CMAJ&lt;/em&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;REFERENCES:&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;
&lt;ol&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Mayer KH, Gelman M, Holmes J, et al. Safety and tolerability of once-daily co-formulated bictegravir, emtricitabine, and tenofovir alafenamide for post-exposure prophylaxis after sexual exposure.&amp;nbsp;&lt;em&gt;JAIDS&lt;/em&gt;. 2022;&amp;nbsp;&lt;em&gt;in press&lt;/em&gt;.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Irvine C, Egan KJ, Shubber Z, et al. Efficacy of HIV postexposure prophylaxis: Systematic review and meta-analysis of nonhuman primate studies.&amp;nbsp;&lt;em&gt;Clinical Infectious Diseases&lt;/em&gt;. 2015 Jun 1;60 Supplement 3:S165-9.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span lang=&quot;EN-US&quot; style=&quot;color: #99ccff;&quot; xml:lang=&quot;EN-US&quot;&gt;Health Canada. Supplement to a new drug submission: Biktarvy.&amp;nbsp;&lt;em&gt;Notice of Compliance&lt;/em&gt;. 2 November 2021.&lt;/span&gt;&lt;/li&gt;
&lt;/ol&gt;

&lt;h2&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h2&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;A new anti-HIV drug has arrived in Thailand&lt;/strong&gt;&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The combination anti-HIV drug Kocitaf was now approved by the Food and Drug Administration of Thailand on February 3, 2021, and is intended for the treatment of adults and adolescents (aged 12 years and over and has It is hoped that the government will soon allow people living with HIV to receive the drug with gold patents and social security. What are the advantages and disadvantages of this drug compared to the current popular formulation (Teevir brand)? First of all, I would like to present a fairly academic content so that the reader can gain a rather in-depth knowledge of the drug.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;Kocitaf contains&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Tenofovir alafenamide fumarate (TAF) 25 mg&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Emtricitabine (FTC) 200 mg&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dolutegravir (DTG) 50 mg&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;Introduction to the division process of the HIV virus&lt;/strong&gt;&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;antiretroviral drugs used to treat people with HIV Multiple combinations are required. This is because the HIV virus is complex in the process of reproduction. HIV is a retro virus, observed by its genetic transcription process, from the underlying RNA to DNA, which appears to be a reverse process. It relies on the resources of white blood cells to regenerate itself, which consists of several steps. both within the nucleus and other elements of the cell Therefore, a single drug is not enough to inhibit the replication of the virus. The rough process of virus propagation is as follows (1) (shown in Figure 1).&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Attaches to the cell wall and enters the cell (Virus entry)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Transcription RNA to make viral DNA (Reverse Transcription)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;into the nucleus, its DNA is inserted into the DNA of the cell (Integration)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;DNA strands are removed as mRNA and Genomic RNA and leave the nucleus. (Transcription)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Viral mRNA is decoded to synthesize proteins to make up new viral components. (Translation)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The protein strands are cut into tiny particles to prepare for cleavage. (Cleavage)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Genomic RNA and synthesized proteins make up several new viruses (Assembly)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The new virus prepares to leave the cell wall intact (Budding and Maturation)&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;img src=&quot;https://cms.pulse-clinic.com/Files/HIV%20MEDS/reproductive-cycle-hiv-1-sites-action-major-classes-antiretroviral-medications-kocitaf%20for%20pep.jpg&quot; width=&quot;900&quot; height=&quot;783&quot; /&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Source: Gandhi M, Gandhi RT. Single-pill combination regimens for treatment of HIV-1 infection. N Engl J Med. 2014;371:248-59.&lt;br /&gt;&amp;copy; 2014 Massachusetts Medical Society. Figure and Legend Reproduced with permission.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h2&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;A new drug of choice for emergency PEP and treating people with HIV&lt;/strong&gt;&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;Kocitaf&lt;/strong&gt;&lt;/span&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt; contains two non-nucleoside reverse transcriptase inhibitors (NNRTIs), &lt;/span&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;TAF&lt;/strong&gt;&lt;/span&gt; &lt;span style=&quot;color: #99ccff;&quot;&gt;and emtricitabine. Combined with one Integrase strand transfer inhibitors (INSTIs), &lt;/span&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;Dolutegravir&lt;/strong&gt;&lt;/span&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;by TAF and Emtricitabine It inhibits HIV viral replication in Process 2 (Reverse transcription) and Dolutegravir inhibits Process 3 (Integration).&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The 2017 Thailand HIV Treatment and Prevention Guidelines state that TDF is the basic antiretroviral drug. It is most commonly used as a first-line treatment. (2) In general, for treatment, TDF is usually taken as one tablet (300 mg) once a day in combination with other antiretrovirals. However, this dosage was quite high. which the drug recipient must take every day continuously Therefore, they are more likely to experience side effects from the use of this drug, such as nephrotoxicity and bone marrow, which requires regular monitoring of kidney function.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;Tenofovir Alafenamide fumarate (TAF)&lt;/strong&gt;&lt;/span&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt; is a new drug that is gaining attention. It can help reduce side effects on kidneys and bones by using doses much lower than TDF.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;Dolutegravir (DTG)&lt;/span&gt;&amp;nbsp;&lt;/strong&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;It is a second-generation integrative inhibitors and was approved by the U.S. Food and Drug Administration (FDA) in 2013 for its high resistance to HIV virus. Tivicay 10, 25, and 50 mg single tablets are available, and Triumeq combined tablets contain Abacavir 600mg, Lamivudine 300mg, Dolutegravir 50mg.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The pharmacokinetics of Dolutegravir is more than 98.9% bound to blood proteins. Its volume of distribution is 17.4 L. The plasma half-life is 14 hours. The drug is metabolized via UGT1A1 and partially via the CYP3A enzyme. It affects CYP3A. When used with dolutegravir, it also affects the level of dolutegravir in the body. For example, antacids or multiionic drugs can decrease dolutegravir levels. The drug is eliminated in the stool by 53%.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;It was found that the food taken with this drug increase the amount of drug absorption but reduces the rate of drug absorption But it is not clinically insignificant. Therefore, this drug may or may not be taken with food.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Interactions between dolutegravir and metformin (for diabetes) were found to increase Metformin levels 2.4-fold and peak Metformin 2-fold.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dolutegravir plus Rifampicin (tuberculosis treatment) has been found to decrease dolutegravir by 54%. Therefore, dolutegravir 50 mg originally taken once a day may need to be increased to twice a day.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dolutegravir side effects such as insomnia, headache, and depression can occur in patients with a history of psychiatric problems. Pregnant women should be careful Especially at less than 8 weeks of gestation, if you have not started antiretroviral therapy. It is advisable to start with another antibody formulation instead. If you are over 8 weeks pregnant, you can receive Dolutegravir under close monitoring by your doctor.&lt;/span&gt;&lt;/p&gt;
&lt;h2&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h2&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;&lt;strong&gt;New recommendation from WHO&lt;/strong&gt;&lt;/span&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;The World Health Organization has released an Update of recommendations on first- and second-line antiretroviral regimens Policy brief 22 July 2019, recommending Dolutegravir over Efavirenz due to less drug&amp;ndash;drug interactions, faster viral suppression, higher genetic barrier to drug resistance Although dolutegravir may cause weight gain, the issue of neural tube defects in infants in Botswana is unclear. and from the study compare with efavirenz-based No differences were found, including the incidence in other countries did not increase.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;KOCITAF is available foremergency HIV prevention (Post-exposure prophylaxis) and for HIV treatment at PULSE CLINIC throughout Thailand.&lt;/span&gt;&lt;/p&gt;

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