A 42 year old male is recently diagnosed with HIV. After a discussion with his healthcare team he agrees to initiate treatment.
Which of the following recommended initial regimens contains abacavir and would require HLA-B*5701 genetic testing before administering?
C. Truvada plus Tivicay
D. Truvada plus Isentress
Answer with rationale:
The correct answer is A. Most pharmacy students have been trained to only speak/write drug therapies as generic names. However in practice and for the exam both names are required. NAPLEX competency statement 2.3.2 states "Commercial availability, identification, and ingredients of prescription and non-prescription drugs". This would include knowledge of brand and generic names of any currently available medication. In my experience as an educator, the brand names that tend to give students the most trouble include oncology medications, asthma/COPD medications, and HIV medications.
Oncology medications tend to cause issues due to the lack of familiarity as well as the explosion in the number of approved products in the last 5 years, especially monoclonal antibodies. Asthma/COPD medications are often problematic as there are a high number of combination therapies so knowing which product is which can be difficult to keep up with. Additionally, there have been a number of errors reported with the "Ellipta" device products, especially Breo Ellipta and Anoro Ellipta.
HIV medications combine both areas of difficulty as there is a lack of familiarity as well as a high number of combination products that contain 2, 3, or even 4 medications. For our question, the correct answer is A as Triumeq contains abacavir as well as dolutegravir and lamivudine. The genetic testing is required first because abacavir in patients with the HLA-B*5701 allele would be contraindicated due to increased risk of fatal hypersensitivity reaction. Biktarvy contains bictegravir, emtricitabine & tenofovir alafenamide. Truvada, often used for PrEP therapy by itself, contains emtricitabine and tenofovir disoproxil fumarate. Tivicay is the brand name for dolutegravir and Isentress is the brand name for raltegravir.
An easy area to trip up are differentiating TAF (tenofovir alafenamide) and TDF (tenofovir disoproxil fumarate). Many products contain one or the other and should be studied with caution as not to miss a question.
See everyone next week!