Fourth STR available

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16 Jun 2015

Hailed as an important step forward in treating HIV, Triumeq is the latest single tablet regimen (STR) to have been approved by the Therapeutic Goods Administration for the treatment of HIV. The drug contains — the clue is in the name — three medications: 600mg abacavir, 300mg lamivudine and 50mg of dolutegravir.

Developed by ViiV Healthcare, and already approved by both the US Food and Drug Administration and the European Union, Triumeq (repeat after me: “Try-oo-mek”) becomes the fourth STR available to people living with HIV in Australia.  

An important point of difference with Triumeq is that all the other STRs — Atripla, Eviplera and Stribild — contain tenofovir, which has been found to be associated with an increase in kidney damage and a decrease in bone mineral density (BDM). Triumeq does not contain tenofovir making it an attractive option for patients with, or who may develop, such conditions.

Tenofovir has been replaced with abacavir. While the drug is perfectly safe to take for most people living with HIV, it is estimated that up to 5% of PLHIV have a genetic hypersensitivity to abacavir which can result in serious allergic reactions including fever, rash, nausea, vomiting, diarrhoea, and stomach pain. (A blood test will determine if someone has a genetic hypersensitivity to abacavir.)

Abacavir has also been associated with a build-up of lactic acid, changes in body fat, and liver problems. Also, studies have thrown up conflicting results as to whether or not abacavir contributes to heart problems.

The primary drug component in Triumeq is dolutegravir — a second-generation integrase inhibitor that has performed like a star in every trial it has been tested in. For those who have developed resistance to raltegravir or elvitegravir, dolutegravir provides an alternative option within the integrase inhibitor class of treatment.

In other tests, Triumeq has been found to show superiority over Atripla. This was based on higher tolerability due to fewer side effects (the most common being insomnia, tiredness and headache). Another selling point for Triumeq is that it has been found to have a high barrier to drug resistance meaning it can be expected to perform well for longer.

Also, Triumeq has no food restrictions (so it can be taken with or without) and people can take the STR regardless of their viral load or CD4 count (other drugs have constraints). Triumeq ticks another box by not causing drowsiness, so it can be taken any time of day.

So, Triumeq in a nutshell: a highly effective, very tolerated, easy to take single-tablet regimen.