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  • 1.  Tivicay & Pifeltro - Any experience?

    Posted 06-06-2024 11:33

    Hi,  Do you have experience using Tivicay and Pifeltro as a regimen? We could also add in Prezcobix, however want to simplify if possible. 



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    Megan Campbell
    Altoona IA
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  • 2.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-06-2024 15:41

    Yes, this regimen works great (DTG/DOR)!  And don't have to worry about ppi's like RPV. 😀



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    James Adams
    Desert Oasis Healthcare
    Palm Desert CA
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    Original Message


  • 3.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-08-2024 00:20

    Yup, agreed. I use it quite a bit (not in coinfected Hep B pts, mind you). Works like a charm. 



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    Scott Denny
    Kaiser Permanente
    Honolulu HI
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    Original Message


  • 4.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-06-2024 20:26

    This is my FAVORITE regimen... especially for anyone with kidney disease... Easy, well tolerated, no worries!



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    Randy Gelow
    Phoenix AZ
    randygelow@gmail.com
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    Original Message


  • 5.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-07-2024 16:55

    If you use this, just keep in mind that it's relatively unstudied and is not active against hepatitis B. Bad things can happen when people with chronic hep B get switched to non-tenofovir-containing regimens.



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    Joel Gallant, MD, MPH
    Santa Fe, NM
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    Original Message


  • 6.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-07-2024 17:42

    I have no experience with this combination; however it sounds interesting in a very limited number of patients and with no evidence to support it. 
    Intolerant patients,  maybe in second or third line in a very "special and rare situation" ?  The problem is that there is no evidence of how this combination fails but probably the failure  will start with Doravirine first and you will be facing a very high probability of loosing all INSTI very rapidly.  I see not many reasons to use it and don't think there will be evidence in the near future.

    For sure I'm not saying it couldn't be used in certain situations but is something I would use only after having discarded all other options available and as Dr Gallant has noted being carful with hepatitis B. 
    Let us know how are your patients going with it. 



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    William Lenis
    Fundacion Valle del Lili
    Cali
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    Original Message


  • 7.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-07-2024 22:10
    Valid Points about Hepatitis B… use caution with this population. I do not have many Hep B Co-infection. This combination (DOR/DTG) is very similar to Juluca but without the dietary restrictions and the higher barrier to resistance than RPV. The nice thing about DOR/DTG is the half life of each medicine is ~14-15 hours so they are metabolized rather similarly and are removed from the system at the same time versus Juluca if the medicine is discontinued or missed.

    I agree this is not a “first” or “second” line agent, but only because there is not a study combining the two of these medicines as all studies are going toward injectables and long acting orals and DTG losing patent soon.

    I look forward to the discussion about this!

    Randy Gelow


    Original Message


  • 8.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-10-2024 11:34

    There is actually some data on the use of this combo  (DTG + DOR): for example https://pubmed.ncbi.nlm.nih.gov/37526898/ and https://pubmed.ncbi.nlm.nih.gov/36113042/  In both studies the combo was well tolerated and both effective and durable for most participants. Incidentally, there is a clinical trial of this regimen currently enrolling in the UK: https://www.clinicaltrials.gov/study/NCT04892654?cond=HIV&term=dolutegravir%20plus%20doravirine&rank=4 . 



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    Michael Luciano
    Charleston SC
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    Original Message


  • 9.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-10-2024 12:38
    Edited by Chiu-Bin Hsiao 06-10-2024 12:40

    I do prefer Dolutegravir plus Doravirine to that of Doluitegravir/Rilpivirine (Juluca) for obvious reason, especially when patients have to have PPI and H2 blocker for GI issues. In addition, from pharmacokinetic point of view, Doravirine half-left ~ 15 hours, Dolutegravir galf-life ~ 14 hours and Rilpivirine half-life ~ 45 hours,

    Similar half-life of Doravirine  and Dolutegravir may reduce the risk of developing drug resistance HIV.  Juluca in patients with potential risk of non-adherences may promote risk of Rilpivirine resistance; then, potentially make Dolutegravir be a single drug therapy for HIV.  I have been using DTG + DOR in patient with moderate to severe kidney disease, including hemodialysis and transplanted patients due to the minimal drug-drug interaction and bioavailability without interference by PPIs or H2 blockers. Still need to be used as stable switch, no potential drug resistance to both agents before the switch. Only patient's complaint has been the large pill size of Doravirine.

    Make sure that patient is immunized for Hep B and is not a HepB carrier.



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    Chiu-Bin Hsiao, MD, FIDSA, AAHIVS
    Allegheny General Hospital - Positive Health Clinic
    Pittsburgh PA
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    Original Message


  • 10.  RE: Tivicay & Pifeltro - Any experience?

    Posted 06-10-2024 13:12

    Yes, I've used in a handful of cases where we couldn't use DTG/RPV, usually because the patient wouldn't have met criteria for RPV (based on inability to take with food and/or acid suppression/PPI need). I've had good success in the handful of patients where it was used, though they were virally suppressed at transition, had no suspected mutations to either component, and were adherent to visits and labs. 



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    John Zeuli
    Rochester MN
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    Original Message