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  • 1.  Can paxlovid and cabenuva be coprescribed?

    Posted 12-21-2022 04:19

    Hi-

     

    I learned something recently that carbotegravir is metabolized by UGT1A1 which means being on Paxlovid would drop carbotegravir levels too low. I'm wondering though if a patient would be willing to ALSO take say dolutegravir (or ral) for a few weeks, could paxlovid be prescribed wo endangering HIV treatment/ protection. I haven't done this but I have at least one patient on cabenuva who is getting repeatedly Covid19 and quite symptomatic (though not hospitalized) so wome people would call the cases "mild". They are not mild to him, and he is unable to work when he gets them (yes he wears a mask)

     

    Thoughts?



  • 2.  RE: Can paxlovid and cabenuva be coprescribed?

    Posted 12-21-2022 15:31
    Cabotegravir/rilpivirine IM  with Paxlovid , No interaction  are  expected . https://ascpt.onlinelibrary.wiley.com/doi/epdf/10.1002/cpt.2646

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    Rakeshkumar Patel
    Johns Hopkins Outpatient Center
    Hampstead MD
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  • 3.  RE: Can paxlovid and cabenuva be coprescribed?

    Posted 12-22-2022 09:55
    While details of your case are lacking I suspect there will not be enough benefit from Paxlovid to consider undertaking this proposition. If Paxlovid provides any benefit which is generally suspect unless extremely immunosuppressed the benefit is seen with immediate use, prior to or immediately with the onset of symptoms. I think it will be hard to arrange for this rapid use and getting additional antiretroviral in place.
     
    It does bring up the point that while injectable are attractive to some patients they do require careful consideration when additional new medications  are needed.
     
    It also brings up the extremely important point that the way to deal with COVID is not to get infected. Should there be sufficient benefit to undergo risks of getting it then being healthy certainly seems to equilibrate the immune system to a normal repair response to the infection. There is no benefit to antiviral medications in this context.
     
    David M. Bebinger, MD
    University of Massachusetts Medical School
    Worcester, Massachusetts
     
     
     
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