Triumeq and Alcohol
The success of antiretroviral therapies (ART) like Triumeq is dependent on patient adherence and the level of care that local health sectors can provide. Out of the many factors that influence patient adherence, the use of alcohol is still under debate. There seems to be many open questions about how it directly and indirectly affect anti-HIV drugs, viral transmission, and virological outcomes. Heavy drinking is an important public health problem, and is usually associated with poor patient compliance to antiretroviral drugs and worsening of side effects. The use of alcohol, especially among patients with HIV/AIDS, requires further investigation and intervention.
Factors associated with nonadherence to anti-HIV treatment
- Patient-related factors (i.e., alcohol and drug abuse)
- Inconvenient dosing frequency
- Dietary restriction
- Pill burden
- Patient-healthcare provider relationships
- System of care
Antiretroviral drug classes
Nucleoside reverse transcriptase inhibitors (NRTI) – blocks the enzyme reverse transcriptase that the virus needs to multiply.
- Abacavir (ABC) – Ziagen
- Emtricitabine (FTC) – Emtriva
- Lamivudine (3TC) – Epivir
- Tenofovir disoproxil fumarate (tenofovir DF, TDF) – Viread
- Zidovudine (AZT, ZDV) – Retrovir
Non-nucleoside reverse transcriptase inhibitors (NNRTI) – binds and alters the activity of reverse transcriptase enzyme
- Efavirenz (EFV) – Sustiva
- Etravine (ETR) – Intelence
- Nevirapine (NVP) – Viramune
- Rilpivirine (RPV) – Edurant
Protease Inhibitors (PI) – blocks the enzyme protease that the virus needs to multiply
- Atazanavir (ATV) – Reyataz
- Darunavir (DRV) – Prezista
- Fosamprenavir (FOS-APV, FPV) – Lexiva
- Ritonavir (RTV) – Norvir
- Saquinavir (SQV) – Invirase
- Tipranavir (TPV) – Aptivus
Fusion Inhibitors – prevents the virus from entering the CD4 cells of the immune system
- Enfuvirtide (T-20) – Fuzeon
CCR5 Antagonists – prevents the virus from entering immune cells by blocking CCR5 co-receptors.
- Maraviroc (MVC) – Selzentry
Integrase Strand Transfer Inhibitors (INSTI) – blocks the enzyme integrase that the virus needs to insert their DNA into the DNA of CD4 cells.
- Dolutegravir (DTG) – Tivicay
- Raltegravir (RAL) – Isentress
Post-Attachment Inhibitors – prevents the virus from entering immune cells by blocking CD4 receptors on cell’s surfaces
- Ibalizumab – Trogarzo
Pharmacokinetic Enhancers – drugs that increases the effectiveness of other HIV drugs in the regimen.
- Cobicistat (COBI) – Tybost
Triumeq: the first single-tablet regimen with an NRTI backbone
Triumeq of ViiV Healthcare is an FDA-approved single-tablet regimen (STR) containing three anti-HIV drugs: abacavir, dolutegravir, and lamivudine. It is the first combination therapy that utilizes a NRTI backbone of abacavir and lamivudine instead of a tenofovir derivative. This medication is indicated for the treatment of HIV-1 infection in adults and children who weigh at least 40 kilograms and without prior resistance to INSTI drug class. Triumeq does not require a pharmacokinetic enhancer such as cobicistat, which means there are fewer drug interactions compared to other tenofovir-containing STRs like Genvoya, Complera, and Stribild.
Impact of alcohol use on HIV/AIDS prevention and treatment
Heavy drinking is common among people living with HIV. The implications of alcohol use have been reviewed in literature with conflicting results. Several authors aimed to show the importance of screening for alcohol abuse among HIV patients because of the following associated risks.
- It interferes with the immune system, thereby increasing occurrence of bacterial infection and enhancing liver damage.
- It increases your risk for coronary heart disease (CHD) and other heart problems.
- It alters the metabolism of antiretroviral drugs.
- It is associated with harmful behavior such as smoking, drug abuse, and engaging in unsafe sexual practices.
- It is considered a risk factor for elevated cancer rates among HIV patients, particularly head, neck, and liver cancers.
- It can lower CD4 cell count.
Effects of Alcohol Intake on Triumeq Regimen
Although medical practitioners are aware of the dangers of alcohol use among patients with comorbidities such as HIV or hepatitis, its effect on Triumeq’s active ingredient abacavir is inconclusive. Some studies suggest that abacavir plus alcohol only poses minor drug interaction and that it may not cause harm or require a change in therapy in some cases. At least 5 drinks of alcohol inhibit the enzyme alcohol dehydrogenase, the same enzyme that helps the natural elimination of abacavir in the blood. This results to an increase amount of the drug in the plasma; however, the clinical significance of this finding is unknown.