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AIDS and HIV Information

AIDS and HIV Information

Triumeq Food Interactions

Triumeq Food Interactions


It is very important to take your HIV treatment properly. While the currently available antiretroviral therapies (ART) cannot cure HIV, they can significantly reduce the amount of virus in your blood and prevent it from reproducing. This could result in undetectable levels of the virus and can help prevent transmission and develop improved immune system that can ward off the long-term effects of HIV. Patients who know about the benefits of antiretroviral drugs and how to take them properly exhibit improved adherence and better treatment outcomes. Taking your treatment properly means the following:

  • Taking the dose prescribed by your healthcare provider;
  • Taking your regimen consistently without missing a dose;
  • Avoiding medications that may interact with your ART regimen;
  • Taking a dose with or without food as prescribed by your healthcare provider.

Consequences of not taking your treatment properly

  • The levels of the drugs in your blood will decrease, and your body will not be able to fight the virus and other infectious diseases.
  • Your viral load will increase, and your immune cells will decrease.
  • You are at risk of transmitting the virus to HIV-negative individuals.
  • The virus can develop resistance to the drugs you are taking.

One of the things you need to learn is the impact of food on the medications you are taking. When doctors prescribe a drug, they relay important information about dietary restrictions. That is because some antiretroviral agents require food to prevent stomach upset, while some need to be taken on an empty stomach for faster absorption.

Antiretroviral class and their food requirements

Triumeq is a first-line treatment for patients who have not been treated with ART in the past. It is also one of the combination regimens that can be taken with or without food. Triumeq is composed of three potent anti-HIV drugs: dolutegravir (DTG), abacavir (ABC), and lamivudine (3TC). These drugs’ absorption and plasma levels are not significantly affected by food intake.

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

Lamivudine, stavudine, abacavir, emtricitabine, tenofovir disoproxil fumarate, and zidovudine can be taken with or without food. Gastric acid impairs the absorption of Didanosine. It should be taken 30 minutes before or two hours after a meal. When paired with tenofovir, it can be taken with food.

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Delavirdine and nevirapine has no food restrictions. Etravirine and rilpivirine must be taken after a meal, as they require gastric acid for absorption. Without a full meal, rilpivirine levels will decrease significantly. Efavirenz must be taken on an empty stomach because fat increases its absorption and may increase the risk of adverse effects.

Protease Inhibitors (PI)

Fosamprenavir, lopinavir, and tipranavir can be taken with or without food. Atazanavir, darunavir, nelfinavir, ritonavir, and saquinavir must be taken with food. Take indinavir on an empty stomach, as heavy meals interfere with its absorption. If unboosted, take it one hour before or two hours after a meal. In the latter case, a light, non-fatty snack will suffice. If boosted with ritonavir, take indinavir with or without food.

Integrase Inhibitors (INSTI)

Raltegravir can be taken with or without food.

Entry Inhibitor

Enfuvirtide and maraviroc have no food requirements or restrictions.

Comparing Food Interactions among Integrase Inhibitor Drugs

Drug

Dose

Type of Meal

AUC

Cmax

Recommendations

Dolutegravir

50mg single dose in healthy subjects

- low fat
- moderate fat
- high fat

- increased by 33%
- increased by 41%
- increased by 66%

- increase by 46%
- increased by 52%
- increased by 67%

You can take dolutegravir with or without food and without regard to fat content.

As part of Triumeq (50mg dolutegravir, 600mg abacavir, 300mg lamivudine) in healthy subjects

High fat meal compared to fasted

Increased by 48%

Increased by 37%

Triumeq can be taken with or without food.

Elvitegravir

As part of Stribild (150mg elvitegravir, 150mg cobicistat, 200mg emtricitabine, 300mg tenofovir disoproxil fumarate) in healthy subjects

Light meal

High fat meal

Increased by 34%
Increased by 87%

Increased by 22%
Increased by 56%

Take Stribild with food.

Raltegravir

400mg single dose

Standard moderate fat meal compared with fasted state

Increased by 13%

Increased by 5%

You may take raltegravir with or without food.

400mg twice a day

Compared to fasting:
- low fat meal
-moderate fat meal
-high fat meal

- Decreased by 46%
- Increased by 13%
-Increased by 111%

- Decreased by 52%
- Increased by 4%
- Increased by 96%

None of these findings is clinically relevant. You may take raltegravir with or without food.

AUC – (area under the curve) actual body exposure to the drug
Cmax – (peak serum concentration) the maximum concentration that the drug achieved in the plasma

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