| TDF-FTC | - Well tolerated.
- Most studied regimen and can be used in all populations.
- Can be administered as event-driven therapy for men who have sex with men; can also be used by other persons who engage only in anal sex*. However, event-driven dosing should be avoided in those with chronic HBV infection.
| - Can result in reduced kidney function.
- Can result in bone loss.
- For patients with chronic HBV, they are at risk for flare of their liver disease if therapy is discontinued.
| - TDF should not be used in persons with an eGFR <60.
- Patients require monitoring of creatinine on therapy.
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| TAF-FTC | - Well tolerated.
- Less bone and renal toxicity compared with TDF.
| - Should only be administered as daily therapy.
- Higher rates of mild triglyceride elevations and weight gain compared with TDF-FTC.
- Considered an alternative agent for those whose main risk for HIV is vaginal (frontal) sex or who inject drugs since there is less data compared with TDF-FTC. There is also limited data in adolescents.
- For patients with chronic HBV, they are at risk for flare of their liver disease if therapy is discontinued.
| - There are no data evaluating event-driven dosing in those taking TAF-FTC.
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| Cabotegravir LA | - Well tolerated.
- Administered every other month.
- Clinical trials suggest efficacy greater than TDF-FTC (possibly related to improved adherence).
- Can be considered for patients with conditions that are associated with an increased risk of adverse events with TDF-FTC or TAF-FTC (eg, those with reduced kidney function, bone disease)*.
| - Cabotegravir LA has a long half-life (drug may be detectable in blood for more than a year). An oral agent (TDF-FTC or TAF-FTC), consistent condom use, or abstinence is needed for a period of time in those who discontinue injectable therapy but continue to engage in behaviors that put them at increased risk for HIV. Oral therapy is also needed if the patient needs to miss a dose of cabotegravir.
- Patients may be at risk of developing an integrase inhibitor-resistant strain if HIV infection is acquired when cabotegravir levels are suboptimal. If this occurs, future HIV treatment options may be limited.
- Need to be near a center that administers cabotegravir LA so doses are not missed.
- Injection site reactions (generally mild).
| - For those who are concerned about side effects of cabotegravir, oral cabotegravir (30 mg once daily) can be administered for a 4-week lead-in period prior to initiating injections.
- There are only limited data in persons who are pregnant or who desire pregnancy.
- Cabotegravir LA has not yet been studied in persons who inject drugs.
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