Fixed-dose combination (FDC) HIV treatment Fact sheet
What is a fixed-dose combination drug? A fixed-combination drug is a drug which combines two or more active pharmaceutical ingredients into a single dose.
What does this mean in terms of HIV treatment in South Africa? In terms of HIV treatment this means that two or more ARVs are combined into a single pill which is taken once a day in the evening. As of 1 April 2013, South Africa has incorporated fixed-dose combination generics into its HIV treatment guidelines:
*Tribuss = (Generic of Atripla) * There are other generics which may also be prescibed for FDC HIV treatment.
EFV + TDF + FTC Efavirenz (600 mg) + Tenofovir (300 mg) + Emtricitabine (200 mg) Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
Nucleoside/Nucleotide Reverse Transcriptase Inhibtors (NRTIs)
HIV must convert its RNA into DNA in order to take over human cells and replicate. NRTIs and NNRTIs curb HIV infection by stopping the reverse transcriptase enzyme from converting HIV’s RNA into DNA. There are other types of ARVs which act on HIV in different ways and at different stages of the virus’ life cycle.
Do all people who need HIV treatment get the single dose regimen? The Government is phasing in FDC HIV treatment over the period of one year. For now only HIV-positive pregnant women and treatment-naive patients will receive fixed-dose combination treatment. All pregnant women, regardless of their CD4 count, will be initiated on FDC HIV treatment the day they are confirmed HIV-positive. AZT prophylaxis and individual triple antiretroviral therapy for pregnant women with a CD4 count of above 350 will now only be available to a small percentage of women who have contraindications to the FDC. After pregnant women and treatment-naive patients, people living with HIV who have co-infections or co-morbidities will be the next priority group. Finally, patients who have been identified as needing to be switched from their current treatment regimen will be initiated onto FDC treatment.
Can single-dose HIV treatment improve adherence? Yes, taking combination HIV treatment in one dose simplifies treatment, making it easier to manage. Previously, the first-line regimen for people living with HIV who qualified for treatment was efavirenz (600 mg), tenofovir (300 mg) and lamivudine (300 mg). But each ARV came in its own separate dose or pill. Taking this individual triple therapy meant remembering to take three pills once a day everyday for the rest of the person’s life. People living with HIV also might have to take treatment for other conditions which can be HIV-related, such as TB. This makes the number of pills a person has to take even higher. FDC HIV treatment can also improve adherence because people can take their treatment more discreetly should they choose to. HIV-related stigma and discrimination is still prevalent and people taking HIV treatment may wish not to disclose their HIV-status.
Can single-dose HIV treatment address drug resistance? Drastically reducing the number of pills a person on HIV treatment has to take translates into better adherence. Strict adherence to HIV treatment regimens is crucial if patients are to avoid developing drug resistance, which makes treatment options more limited and more expensive.
The HIV&AIDS Media Project is an initiative of the Wits Journalism Programme and the Anova Health Institute. The project is funded by the President’s Emergency Fund for AIDS Relief (PEPFAR) thrugh the United Satates Agency for Internaitonal Development (USAID) under Johns Hopkins Health and Education South Africa (JHHESA).