[팜뉴스=김민건 기자] RapIT (Rapid Initiation of Treatment), which involves initiation of antiretroviral therapy (ART) within 7 days of diagnosis of HIV infection, is becoming a global trend in HIV treatment. Even in Korea, the time to start treatment after HIV diagnosis has increased five times earlier, increasing the importance of “treatment on the same day as diagnosis.”
Same-day therapy, which evolved from the rapid treatment concept that appeared in 2015, is becoming a paradigm for maintaining a healthy life. There are treatments that allow for significant changes in this process. Biktarvy developed by Gilead Sciences. Taking Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide fumarate) on the day of diagnosis can increase the rate of viral suppression to 92.2% (week 48). If you receive good treatment, you will be able to enjoy a normal daily life.
▶ Biktarvy, the only treatment that can be treated on the same day, maintains 92% viral suppression.
Among the HIV treatments currently prescribed in Korea, Biktarvy is the only drug that can be used for same-day treatment. It can be prescribed without acute HIV infection and without prior testing for hepatitis B and C before the results of genetic drug resistance testing are available. This is why the U.S. Department of Health and Human Services (DHHS) recommends the use of Biktarvy when initiating ART before the results of a genotypic drug resistance test are available through guidelines .
Among Biktarvy’s clinical studies is a FAST study that confirmed prognosis through the efficacy and tolerability of same-day treatment. At 28 weeks following administration of Biktarvy as same-day treatment, 87.4% suppressed HIV RNA, and at 48 weeks 92.2% achieved suppression.
FAST study analyzing the impact of same-day treatment with Biktarvy
Additionally, there are results showing that rapid treatment reduces tuberculosis and other serious bacterial infections in HIV-infected people, while showing similar safety to delayed treatment. For example, the START trial compared 42 HIV patients who received rapid treatment with 96 who received delayed treatment. Patients who received accelerated treatment had 57% lower rates of AIDS-related events, unrelated events, and all-cause mortality in the primary endpoint compared to patients who received delayed treatment. The mortality rate of patients who received timely treatment was reduced by half.
START study analyzing the impact of rapid and delayed treatment
The HIV virus attacks the body’s immune cells, the immune function protein CD4. If the average CD4 count for the general population is between 600 and 700 cells/uL, the number for patients drops to less than 200 cells/uL. In the past, the standard treatment for HIV was delayed treatment, which involved waiting until CD4 counts fell and then giving ART. For this reason, when RapIT was introduced, opinions on rapid treatment were divided. With the emergence of effective and safe same-day treatments, such as Biktarvy, the clinical benefits of RapIT have become clear and it has now become a key treatment strategy.
Heo Joong-yeon, professor of infectious diseases at Ajou University Hospital, said: “In the past, it was essential to check test results before using a treatment depending on the patient’s condition or treatment characteristics, and this led to delays in treatment. However, clinical research conducted in 2015 revealed the benefits of rapid treatment: “It is highlighted as an important therapeutic strategy,” he said.
Professor Heo said: “The reason why rapid treatment is possible is because the efficacy and safety of treatments have improved significantly compared to the past. According to one study, when patients were followed up to the 90th day, the rapid treatment group retained 100% “Rapid treatment is not only good for patients in terms of maintaining treatment, but also helps prevent the spread of HIV to patients.” uninfected people.”
▶ HIV Treatment Trend Another benefit of RapIT is “anxiety relief”
There are advantages to same-day treatment. Ease the anxiety of people living with HIV. There is currently a lack of correct information and awareness about HIV disease. In Korea, there are many cases where people complain of frustration and anxiety when they are diagnosed with HIV infection. In the medical field it is believed that receiving a treatment prescription on the day of diagnosis can help relieve the anxiety of infected patients with vague fears.
Previously, Professor Heo said: “Biktarvy is a very useful treatment option as it can be prescribed immediately even before the results of the genotypic drug resistance test are confirmed, provided that the HIV-infected person goes to to the doctor on the same day as the hospital visit.”
He continued: “Patients who arrive at hospital late because they have been infected for a long time due to lack of adequate symptoms may urgently need rapid viral suppression and, even in these cases, it may be helpful. The quicker the treatment, the more “Viral suppression is more rapid, so the clinical benefit is evident. The infected person is anxious. “It can have a positive impact on the quality of life of infected people as it can solve the problem,” she emphasized.
▶ Global guidelines emphasize “same day treatment” immediately after diagnosis… Not all treatments are possible
Global HIV treatment guidelines also recognize the clinical benefit of rapid treatment. International treatment guidelines, including the WHO, the US Department of Health and Human Services, the International Antiviral Society-USA (IAS-USA), and the European AIDS Clinical Society (EACS), all recommend treatment as soon as possible after recognition of the infection. There is a strong recommendation to start treatment.
In particular, in addition to rapid treatment, expressions such as “immediately after diagnosis” or “the same day of diagnosis” are used. The reason we emphasize the concept of “same-day treatment,” meaning that ART treatment should be started immediately even on the day of diagnosis, is because patients who received same-day treatment were found to have a high rate of suppression viral load and treatment retention rate at 12 months.
For this reason, many Asian countries are gaining experience with same-day treatment or rapid treatment. Taiwan prescribes antiretroviral therapy for free under the national insurance system and has introduced a rapid treatment program in earnest since 2018. Through various measures, the proportion of infected people starting antiretroviral therapy within 7 days of infection has increased significantly since 14% in 2017 to 67% in 2020. Thailand also has a national insurance system that covers both treatment and testing. Same-day treatment has been officially recommended nationally through the 2020 and 2021 National Treatment Guidelines.
However, not all HIV treatments can be given on the same day. HIV treatments require preliminary testing before prescribing. In particular, the suitability of the treatment must be confirmed based on the results of the genotypic drug resistance test. Prompt treatment is important, but you should at least wait until the results of a genotypic drug resistance test are released. Also, people infected with hepatitis B may have difficulty using some treatments. Testing for hepatitis B should be done first. There is also a priority recommended option which can only be prescribed after confirming if the HIV RNA level is above 500,000 copies/ml and the CD4 cell count is below 200 cells/μL.
2024-01-01 21:00:00
#명약만리 #Biktarvy #diagnose #prescribe #HIV #day #bringing #shift #treatment #paradigm