Infectivology Xagena

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Xagena Newsletter
Medical Meeting

Prophylaxis to reduce risk of acquiring HIV: Truvada

Gilead Sciences has announced that the Antiviral Drugs Advisory Committee of the FDA ( Food and Drug Administration ) has voted to support approval of once-daily oral Truvada ( Emtricitabine and Tenofovir disoproxil fumarate ) to reduce the risk of HIV-1 infection among uninfected adults, an HIV prevention strategy called pre-exposure prophylaxis ( PrEP ). If the FDA decides to approve Truvada for pre-exposure prophylaxis, it would be the first agent indicated for uninfected individuals to reduce their risk of acquiring HIV.

In response to questions posed to the Committee, members voted 19 to 3 in favor of approval for Truvada for pre-exposure prophylaxis in men who have sex with men; 19 to 2 ( with 1 abstaining ) in support of use in HIV-uninfected partners in serodiscordant couples; and 12 to 8 ( with 2 abstaining ) in other individuals at risk for acquiring HIV through sexual activity.

The Committee’s positive recommendation followed presentations of efficacy and safety data from several clinical studies of Truvada for pre-exposure prophylaxis, including two large placebo-controlled Phase 3 trials sponsored by the National Institutes of Health ( NIH ) and the University of Washington, respectively. Several other clinical studies support the use of Truvada for HIV risk reduction.

Truvada was approved by the FDA in 2004 for the treatment of HIV-1 infection and is currently the most-prescribed antiretroviral treatment in the United States.

Important safety information about Truvada

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs, including Tenofovir disoproxil fumarate, a component of Truvada, in combination with other antiretrovirals.

Truvada is not approved for the treatment of chronic hepatitis B virus ( HBV ) infection and the safety and efficacy of Truvada have not been established in patients coinfected with HBV and HIV-1. Severe acute exacerbations of hepatitis B have been reported in patients who are coinfected with HBV and HIV-1 and have discontinued Truvada. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who are coinfected with HIV-1 and HBV and discontinue Truvada. If appropriate, initiation of anti-hepatitis B therapy may be warranted.

New onset or worsening of renal impairment may also occur, including acute renal failure and Fanconi syndrome. Creatinine clearance should be calculated prior to administering Truvada. Truvada should not be used in patients with severe renal disease ( CrCl less than 30 mL/min ), and routine monitoring of CrCl and serum phosphorous in patients at risk for renal impairment is recommended. Avoid administering concurrently with or with recent use of nephrotoxic drugs.

Truvada should not be co-administered with any other antiretroviral agents for HIV that contain Emtricitabine or Tenofovir disoproxil fumarate, nor should it be co-administered with products containing Lamivudine. Do not administer with Hepsera ( Adefovir dipivoxil ). Decreases in bone mineral density, fat redistribution and immune reconstitution syndrome may also occur. Common side effects reported during clinical studies with Truvada ( in combination with Efavirenz ) include diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams and rash. Caution should be exercised when co-administering Truvada with Didanosine, Atazanavir and Lopinavir / Ritonavir due the potential for toxicity. ( Xagena )
Source: Gilead Sciences, 2012