Medscape InDiscussion: HIV Medscape

Drs Michael S. Saag and Charles W. Flexner discuss the mechanisms of drug-drug interactions and the promise and limitations of longer-acting HIV therapeutics for both treatment and prevention.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986504). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview
Drug Interactions With Antiretroviral Therapy (ART) https://emedicine.medscape.com/article/2039809-overview
Common Drug Interactions With Protease Inhibitors https://emedicine.medscape.com/article/2041624-overview
HIV-Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/9562584/
The Role of Drug Metabolizing Enzymes in Clearance https://pubmed.ncbi.nlm.nih.gov/24392841/
AIDS Clinical Trials Group https://actgnetwork.org/
Ritonavir https://reference.medscape.com/drug/norvir-ritonavir-342627
The Cytochrome P450 Isoenzyme and Some New Opportunities for the Prediction of Negative Drug Interaction In Vivo https://pubmed.ncbi.nlm.nih.gov/29780235/
Boosting https://clinicalinfo.hiv.gov/en/glossary/boosting
Cytochrome p450 Structure, Function and Clinical Significance: A Review https://pubmed.ncbi.nlm.nih.gov/28124606/
Darunavir https://reference.medscape.com/drug/prezista-darunavir-342647
Atazanavir https://reference.medscape.com/drug/reyataz-atazanavir-342608
Tenofovir Disoproxil Fumarate https://clinicalinfo.hiv.gov/en/drugs/tenofovir-disoproxil-fumarate/patient
The Structure and Mechanism of Drug Transporters https://pubmed.ncbi.nlm.nih.gov/34272696/
Tenofovir Alafenamide (TAF) Clinical Pharmacology https://pubmed.ncbi.nlm.nih.gov/35146360/
Prodrugs for Improved Drug Delivery: Lessons Learned From Recently Developed and Marketed Products https://pubmed.ncbi.nlm.nih.gov/33137942/
Update on Drug-Drug Interaction at Organic Cation Transporters: Mechanisms, Clinical Impact, and Proposal for Advanced In Vitro Testing https://pubmed.ncbi.nlm.nih.gov/33896325/
The Role of Organic Anion Transporting Polypeptides in Drug Absorption, Distribution, Excretion and Drug-Drug Interactions https://pubmed.ncbi.nlm.nih.gov/27783531/
Creatinine Clearance https://pubmed.ncbi.nlm.nih.gov/31334948/
Dolutegravir https://reference.medscape.com/drug/tivicay-tivicay-pd-dolutegravir-999861
Cobicistat https://reference.medscape.com/drug/tybost-cobicistat-999845
Paxlovid https://pubmed.ncbi.nlm.nih.gov/35138785/
Interaction Between Ritonavir and Statins https://pubmed.ncbi.nlm.nih.gov/11959074/
COVID-19 Drug Interactions https://www.covid19-druginteractions.org/checker
Cabotegravir https://reference.medscape.com/drug/vocabria-apretude-cabotegravir-1000364
Lenacapavir https://reference.medscape.com/drug/sunlenca-lenacapavir-4000240
Inhibitors of the HIV-1 Capsid, a Target of Opportunity https://pubmed.ncbi.nlm.nih.gov/29782334/
Flip-Flop Pharmacokinetics--Delivering a Reversal of Disposition: Challenges and Opportunities During Drug Development https://pubmed.ncbi.nlm.nih.gov/21837267/
Polymeric Biomaterials for Medical Implants and Devices https://pubmed.ncbi.nlm.nih.gov/33465850/
Microneedle Arrays Combined With Nanomedicine Approaches for Transdermal Delivery of Therapeutics https://pubmed.ncbi.nlm.nih.gov/33419118/
Preexposure HIV Prophylaxis https://emedicine.medscape.com/article/2054869-overview

Drs Michael S. Saag and Monica Gandhi discuss COVID-19 and the impact this pandemic has had on patients diagnosed with HIV, including vaccines, boosters, and patients who are older or have chronic comorbid conditions.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986505). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Coronavirus Disease 2019 (COVID-19) https://emedicine.medscape.com/article/2500114-overview
HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview
HIV https://www.who.int/news-room/fact-sheets/detail/hiv-aids
Molnupiravir, an Oral Antiviral Treatment for COVID-19 https://pubmed.ncbi.nlm.nih.gov/34159342/
Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients https://pubmed.ncbi.nlm.nih.gov/34914868/
Molnupiravir for the Treatment of COVID-19 in Immunocompromised Participants: Efficacy, Safety, and Virology Results From the Phase 3 Randomized, Placebo-Controlled MOVe-OUT Trial https://pubmed.ncbi.nlm.nih.gov/36648627/
Molnupiravir Plus Usual Care Versus Usual Care Alone as Early Treatment for Adults With COVID-19 at Increased Risk of Adverse Outcomes (PANORAMIC): An Open-Label, Platform-Adaptive Randomised Controlled Trial https://pubmed.ncbi.nlm.nih.gov/36566761/
Paxlovid https://pubmed.ncbi.nlm.nih.gov/35138785/
Protease Inhibitors as Promising Weapons Against COVID-19: Focus on Repurposing of Drugs Used to Treat HIV and HCV Infections https://pubmed.ncbi.nlm.nih.gov/34727849/
A Trial of Lopinavir-Ritonavir in Adults Hospitalized With Severe Covid-19 https://pubmed.ncbi.nlm.nih.gov/32187464/
Tenofovir Disoproxil Fumarate and Coronavirus Disease 2019 Outcomes in Men With HIV https://pubmed.ncbi.nlm.nih.gov/35848570/
Development of COVID-19 Vaccines–An Unanticipated Moon Shot Achieved at Warp Speed https://pubmed.ncbi.nlm.nih.gov/36689231/
Emerging Viral Diseases From a Vaccinology Perspective: Preparing for the Next Pandemic https://pubmed.ncbi.nlm.nih.gov/29199281/
A Bivalent Omicron-Containing Booster Vaccine Against Covid-19 https://pubmed.ncbi.nlm.nih.gov/36112399/
New Boosters Are Here! Who Should Receive Them and When? https://pubmed.ncbi.nlm.nih.gov/36354037/
Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients https://pubmed.ncbi.nlm.nih.gov/35653428/
Nirmatrelvir Use and Severe Covid-19 Outcomes During the Omicron Surge https://pubmed.ncbi.nlm.nih.gov/36001529/

Drs Michael S. Saag and Ellen F. Eaton discuss HIV and opioid use disorder, including opioid agonists for chronic pain management, tools for reducing mortality, and management in the outpatient setting.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986506). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Opioid Use Disorders in People Living With HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders https://pubmed.ncbi.nlm.nih.gov/32932786/
Opioid Abuse https://emedicine.medscape.com/article/287790-overview
Opioids https://nida.nih.gov/research-topics/opioids
Drug Abuse Statistics https://drugabusestatistics.org/
Opioid Continuum of Care for Persons Living With HIV: The First 8 Months https://academic.oup.com/ofid/article/7/Supplement_1/S186/6058436
Medications to Treat Opioid Use Disorder Research Report: Overview https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview
Buprenorphine https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine
Screening Tools https://ssc.jsi.com/resources/substance-use-screening-tools/list
The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) https://www.who.int/publications/i/item/978924159938-2
NIDA Quick Screen V1.0 https://nida.nih.gov/sites/default/files/pdf/nmassist.pdf
Rapid Opioid Dependence Screen (RODS) https://ssc.jsi.com/resources/substance-use-screening-tools/rapid-opioid-dependence-screen-rods
Removal of Data Waiver (X-Waiver) Requirement https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement
Naloxone DrugFacts https://nida.nih.gov/publications/drugfacts/naloxone
Endocarditis in Patients With Cocaine or Opioid Use Disorder Markedly Increased Between 2011 and 2022 https://nida.nih.gov/news-events/news-releases/2022/12/endocarditis-in-patients-with-cocaine-or-opioid-use-disorder-markedly-increased-between-2011-to-2022#:~:text=The%20incidence%20rate%20of%20infective,2022%2C%20a%20new%20study%20reports.
Buprenorphine Initiation Strategies for Opioid Use Disorder and Pain Management: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/35302671/
Low Barrier Medication for Opioid Use Disorder at a Federally Qualified Health Center: A Retrospective Cohort Study https://pubmed.ncbi.nlm.nih.gov/36335381/

Drs Michael S. Saag and Roger Bedimo discuss weight gain after starting antiretroviral therapy, including risk factors, long-term outcomes, and patients' well-being.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986507). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Weight Gain on INSTI-Based HIV Antiretrovirals https://www.medscape.com/viewarticle/916095#vp_2
Lipodystrophy in HIV Clinical Presentation https://emedicine.medscape.com/article/1082199-clinical
Protease Inhibitors' Metabolic Side Effects: Cholesterol, Triglycerides, Blood Sugar, and 'Crix Belly.' Interview With Lisa Capaldini, MD. Interview by John S. James https://pubmed.ncbi.nlm.nih.gov/11364559/
Reduced Survival After Serious Non-AIDS Complications https://www.medscape.com/viewarticle/721773
HIV Protease Inhibitor-Related Lipodystrophy Syndrome https://pubmed.ncbi.nlm.nih.gov/10860898/
Antiretroviral Therapy for HIV Infection https://emedicine.medscape.com/article/1533218-overview
Integrase Strand Transfer Inhibitor (INSTI) https://clinicalinfo.hiv.gov/en/glossary/integrase-strand-transfer-inhibitor-insti
Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) https://clinicalinfo.hiv.gov/en/glossary/non-nucleoside-reverse-transcriptase-inhibitor-nnrti
Strategies to Prevent Weight Gain Among Adults https://pubmed.ncbi.nlm.nih.gov/23638485/
Tenofovir Alafenamide (TAF) Clinical Pharmacology https://pubmed.ncbi.nlm.nih.gov/35146360/
Associations Between Integrase Strand-Transfer Inhibitors and Cardiovascular Disease in People Living With HIV: A Multicentre Prospective Study From the RESPOND Cohort Consortium https://pubmed.ncbi.nlm.nih.gov/35688166/
Adipokines, Weight Gain and Metabolic and Inflammatory Markers After Antiretroviral Therapy Initiation: AIDS Clinical Trials Group (ACTG) A5260s https://pubmed.ncbi.nlm.nih.gov/34117756/
Is Tenofovir Disoproxil Fumarate Associated With Weight Loss? https://pubmed.ncbi.nlm.nih.gov/34848586/
Switching From Boosted PIs to Dolutegravir Decreases Soluble CD14 and Adiponectin in High Cardiovascular Risk People Living With HIV https://pubmed.ncbi.nlm.nih.gov/34120186/
Adiponectin: A Fat Cell Hormone That Promotes Insulin Sensitivity https://www.medscape.org/viewarticle/438373
Glucagon-like Peptide-1 Analogues: An Overview https://pubmed.ncbi.nlm.nih.gov/23869296/
Dolutegravir Plus Two Different Prodrugs of Tenofovir to Treat HIV https://pubmed.ncbi.nlm.nih.gov/31339677/
Weight and Metabolic Changes After Switching From Tenofovir Alafenamide (TAF)/Emtricitabine (FTC)+Dolutegravir (DTG), Tenofovir Disoproxil Fumarate (TDF)/FTC+DTG and TDF/FTC/Efavirenz (EFV) to TDF/Lamivudine (3TC)/DTG https://pubmed.ncbi.nlm.nih.gov/36519389/
The ADVANCE Study: A Groundbreaking Trial to Evaluate a Candidate Universal Antiretroviral Regimen https://pubmed.ncbi.nlm.nih.gov/28538284/

Drs Michael S. Saag and David H. Spach discuss HIV and the nuances of primary care treatment, with a special focus on vaccines, including COVID, hepatitis, varicella zoster virus, and mpox.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986508). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview
HIV and Immunizations https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-immunizations
HRSA Ryan White HIV/AIDS Program https://ryanwhite.hrsa.gov/about/parts-and-initiatives
Pneumococcal Vaccination https://www.cdc.gov/pneumococcal/vaccination.html
Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Positive Individuals in the Era of Highly Active Antiretroviral Therapy https://pubmed.ncbi.nlm.nih.gov/30999829/
Pneumococcal 7-Valent Conjugate Vaccine https://www.cancer.gov/publications/dictionaries/cancer-drug/def/pneumococcal-7-valent-conjugate-vaccine
Immunizations for Preventable Diseases in Adults and Adolescents Living With HIV https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/immunizations
Drug Database: Hepatitis B Vaccine https://clinicalinfo.hiv.gov/en/drugs/hepatitis-b-vaccine/patient
Interpretation of Hepatitis B Laboratory Results https://www.cdc.gov/hepatitis/statistics/surveillanceguidance/docs/viral-hepatitis-surveillance-table-3-1_508.pdf
Screening and Testing for Hepatitis B Virus infection: CDC Recommendations — United States, 2023 https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm?s_cid=rr7201a1_w
Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV: Hepatitis B Virus Infection https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-b-0?view=full
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens
Cabotegravir/Rilpivirine (Rx) Cabenuva (cabotegravir/rilpivirine) dosing, indications, interactions, adverse effects, and more https://reference.medscape.com/drug/cabenuva-cabotegravir-rilpivirine-4000156
Dolutegravir/Lamivudine as a First-Line Regimen in a Test-and-Treat Setting for Newly Diagnosed People Living With HIV https://pubmed.ncbi.nlm.nih.gov/34115650/
Systematic Review and Meta-analysis of Immune Response of Double Dose of Hepatitis B Vaccination in HIV-Infected Patients https://pubmed.ncbi.nlm.nih.gov/32334887/
Heplisav-B® (HepB-CpG) Vaccine https://www.cdc.gov/vaccines/schedules/vacc-updates/heplisav-b.html
PreHevbrio: A New 3-Antigen Hepatitis B Vaccine for Adults https://pubmed.ncbi.nlm.nih.gov/35906803/
Hepatitis A Vaccine Inactivated (Rx) https://reference.medscape.com/drug/vaqta-havrix-hepatitis-a-vaccine-inactivated-343150
Hepatitis A/B Vaccine (Rx) https://reference.medscape.com/drug/twinrix-hepatitis-a-b-vaccine-343152
Zoster Vaccine Recombinant (Rx) https://reference.medscape.com/drug/shingrix-zoster-vaccine-recombinant-1000163
Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm#:~:text=On%20October%2020%2C%202021%2C%20ACIP,for%20use%20in%20immunocompromised%20persons.
Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine) https://www.cdc.gov/flu/prevent/nasalspray.htm
MMR Vaccine https://www.ncbi.nlm.nih.gov/books/NBK554450/

Drs Michael S. Saag and Rajesh Gandhi discuss HIV and Antiretroviral Therapy Guidelines. When to begin treatment, which treatment to choose, and how to treat the whole person, not just the HIV.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986509). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview
Zidovudine (Rx) https://reference.medscape.com/drug/retrovir-zdv-zidovudine-342639
ddI and d4T Plus Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/11364012/
HIV-Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/9562584/
Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection https://pubmed.ncbi.nlm.nih.gov/26192873/
Early Symptomatic HIV Infection https://reference.medscape.com/article/211873-overview
IAS-USA https://www.iasusa.org/
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel https://pubmed.ncbi.nlm.nih.gov/36454551/
Integrase Strand Transfer Inhibitors Are Effective Anti-HIV Drugs https://pubmed.ncbi.nlm.nih.gov/33572956/
Dolutegravir (Rx) https://reference.medscape.com/drug/tivicay-tivicay-pd-dolutegravir-999861
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy) https://www.medscape.com/viewarticle/941921_4
Dolutegravir/Lamivudine as a First-Line Regimen in a Test-and-Treat Setting for Newly Diagnosed People Living With HIV https://pubmed.ncbi.nlm.nih.gov/34115650/
Tenofovir DF (Rx) https://reference.medscape.com/drug/viread-tenofovir-df-342633
Tenofovir AF (Rx) https://reference.medscape.com/drug/vemlidy-tenofovir-af-1000007
Abacavir (Rx) https://reference.medscape.com/drug/ziagen-abacavir-342600
HLA B 5701 Testing https://www.ncbi.nlm.nih.gov/books/NBK560797/
Dolutegravir/Rilpivirine (Rx) https://reference.medscape.com/drug/juluca-dolutegravir-rilpivirine-1000216
Efficacy and Safety of Dolutegravir-Rilpivirine for Maintenance of Virological Suppression in Adults With HIV-1: 100-Week Data From the Randomised, Open-Label, Phase 3 SWORD-1 and SWORD-2 Studies https://pubmed.ncbi.nlm.nih.gov/31307948/
Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) https://clinicalinfo.hiv.gov/en/glossary/non-nucleoside-reverse-transcriptase-inhibitor-nnrti
Cabotegravir/Rilpivirine: The Last FDA-Approved Drug to Treat HIV https://pubmed.ncbi.nlm.nih.gov/35596583/
Anticipating and Managing Drug Interactions: Pharmacokinetics of Long-Acting HIV Treatment and Prevention Formulations https://www.medscape.com/viewarticle/986504
Mpox Vaccination Basics https://www.cdc.gov/poxvirus/mpox/vaccines/index.html
COVID-19 Treatment Guidelines https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/summary-recommendations/
Mpox in People With Advanced HIV Infection: A Global Case Series https://pubmed.ncbi.nlm.nih.gov/36828001/
Information for Healthcare Providers: Tecovirimat (TPOXX) for Treatment of Mpox https://www.cdc.gov/poxvirus/mpox/clinicians/obtaining-tecovirimat.html
HIV and Opioid Use Disorder: Screening Tools, Chronic Pain Management, and Access to Care in the Outpatient Setting https://www.medscape.com/viewarticle/986506