BHIVA antiretroviral guidelines updated (2016)
Simon Collins, HIV i-Base
In August 2016, BHIVA published the interim update to the 2015 BHIVA antiretroviral guidelines.
Changes include interim consensus opinion by the panel on newly approve HIV drugs, with the full GRADE analyses planned for the full guideline update in 2017.
- Tenofovir alafenamide/emtricitabine (TDF/FTC) is now included with tenofovir DF/emtricitabine (TDF/FTC) as a preferred NRTI backbones for first-line therapy. In the absence of bone, renal or other concerns, both dual formulations are equally recommended. However the guidelines note that highest benefits from using TAF with be in people with higher risk for bone and renal complications, noting the generic TDF is likely to shortly be available.
- As a substrate of p-glycoprotein (pgp), there are potential drug-drug interactions for TAF that do not apply to TDF [SPC]. Co-administration of pgp inducers (including some anticonvulsants, rifamycins and St John’s wort) with tenofovir may result lower tenofovir concentrations and loss of efficacy. Rifampicin and other rifamycins induce P-glycoprotein and are therefore expected to decrease the absorption of TAF ; TAF is therefore not recommended.
- Previous references to tenofovir now specify TDF or TAF.
- Use of TDF or TAF without either 3TC or FTC is included as an option when genotypic resistance tests show HIV or HBV resistance to 3TC/FTC. This reference is not clear as presumably drug resistance to only one of these viruses would still maintain sensitivity to the other.
- Many previous references to ritonavir-boosted atazanavir or darunavir protease inhibitor therapy (PI/r) now also include cobicistat (PI/c)
- Updates to the chronic kidney disease and bone disease sections of special populations.
- Small changes to managing virological failure.
All changes to the updated guideline are highlighted in yellow.
for the treatment
of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update)