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  • 1.  Apretude & HIV test

    Posted 08-22-2022 16:47
    It is my understanding that prior to each Apretude injection, a patient should be tested for HIV. We dispense Apretude to physicians' offices to administer. Some of our ID physicians are testing patients quarterly, as they did with the po PrEP and they insist this is acceptable. Can someone give me guidance on this? Thanks! 

    Sandy Tzaferos, PharmD
    MediLink RxCare

  • 2.  RE: Apretude & HIV test

    Posted 08-23-2022 15:22
    The CDC Guidelines for PrEP initiation and management recommends more specific testing, as noted in the table above.  Management of cabo for PrEP *IS DIFFERENT* than management of oral PrEP!  HIV Ag/AB testing alone is not appropriate - you need to be able to do HIV-1 RNA q 2 months.  Please read entire guidelines:  
    Gina Bailey Herring AAHIVS

    Gina Bailey Herring MSN, MSCM, APRN
    Clinical Research Nurse Practitioner, Emory University
    Colposcopy Clinic, Grady Infectious Disease Program
    404-727-0806 desk
    404-712-9127 e-fax
    678-463-2216 cell
     cell:    678-463-2216

  • 3.  RE: Apretude & HIV test

    Posted 08-23-2022 17:28
    Hi Sandy,

    The current package insert recommendations (and CDC guidelines) say to check an HIV test before EACH Apretude injection, and this should likely be an HIV RNA test, either quantitative or qualitative.  The reasoning for this is that patients on PrEP who do develop HIV infection may have a delay in developing HIV antibodies, due to the immune system being exposed to  a much lower quantity of virus.  Therefore, if someone on Apretude (or Descovy or Truvada) has a falsely negative HIV Ab or Ab/Ag test, there may be enough time  for the virus to develop resistance to the medication(s) in a non suppressive regimen.  We certainly don't want patients to develop INSTI resistance, so I feel strongly that we should follow this recommendation.  So maybe you could help guide the ID docs in your area who are not doing this.  One problem with this strategy is the added cost, and some insurances may not fully cover the cost of an HIV RNA assay.   Hope this helps.

    Adam Zweig
    AIDS Healthcare Foundation
    San Diego CA

  • 4.  RE: Apretude & HIV test

    Posted 08-23-2022 17:42
    Yes, we always do the HIV RNA testing prior to each Apretude injection.  We are looking into a qualitative RNA instead of a quantitative RNA to help with cost. But regardless, we are adamant about RNA testing prior to every injection.

    Katy Garrett
    Lexington KY

  • 5.  RE: Apretude & HIV test

    Posted 08-23-2022 17:50
    Thank you, everyone for your responses. I will certainly take your recommendations and apply to my practice 

    Sandy Tzaferos,PharmD
    MediLink RxCare 

  • 6.  RE: Apretude & HIV test

    Posted 08-24-2022 17:05
    We looked into the qualitative and found they were about $50 different in price through Quest, which was disappointing. Was hoping for more cost savings!

    Carly Floyd
    Albuquerque NM