A clinical review of HIV integrase strand transfer inhibitors (INSTIs) for the prevention and treatment of HIV-1 infection.

Integrase strand transfer inhibitors (INSTIs) have improved the treatment of human immunodeficiency virus (HIV). There are currently four approved for use in treatment-naïve individuals living with HIV; these include first generation raltegravir, elvitegravir, and second generation dolutegravir and bictegravir. The most recent INSTI, cabotegravir, is approved for (1) treatment of HIV infection in adults to replace current antiretroviral therapy in individuals who maintain virologic suppression on a stable antiretroviral regimen without history of treatment failure and no known resistance to its components and (2) pre-exposure prophylaxis in individuals at risk of acquiring HIV-1 infection. Cabotegravir can be administered intramuscularly as a monthly or bi-monthly injection depending on the indication. This long-acting combination has been associated with treatment satisfaction in clinical studies and may be helpful for individuals who have difficulty taking daily oral medications. Worldwide, second generation INSTIs are preferred for treatment-naïve individuals. Advantages of these INSTIs include their high genetic barrier to resistance, limited drug-drug interactions, excellent rates of virologic suppression, and favorable tolerability. Few INSTI resistance-associated mutations have been reported in clinical trials involving dolutegravir, bictegravir and cabotegravir. Other advantages of specific INSTIs include their use in various populations such as infants and children, acute HIV infection, and individuals of childbearing potential. The most common adverse events observed in clinical studies involving INSTIs included diarrhea, nausea, insomnia, fatigue, and headache, with very low rates of treatment discontinuation versus comparator groups. The long-term clinical implications of weight gain associated with second generation INSTIs dolutegravir and bictegravir warrants further study. This review summarizes key clinical considerations of INSTIs in terms of clinical pharmacology, drug-drug interactions, resistance, and provides perspective on clinical decision-making. Additionally, we summarize major clinical trials evaluating the efficacy and safety of INSTIs in treatment-naïve patients living with HIV as well as individuals at risk of acquiring HIV infection.

Improving pharmacy students' empathy and attitudes regarding opioid overdose and substance use disorder in a skills-based learning environment.

INTRODUCTION: Using a skills-based learning environment as a launch pad for developing empathy for patients with substance use disorder or at high risk for opioid overdose allows for learning continuity and early intervention. Empathy for this patient population may reduce bias and stigma associated with negative health outcomes. Previous studies have assessed empathy in pharmacy students, but not in the context of substance use disorder and opioid overdose harm reduction among first professional year pharmacy students in skills-based education. This cohort study aimed to measure the change in empathy and opioid overdose-related attitudes before and after a two-part skills-based learning activity that focused on drug diversion and opioid overdose treatment. METHODS: First professional year pharmacy students were given a pre- and post-survey consisting of empathy and attitudes sections. The Kiersma-Chen Empathy Scale (KCES) and the Opioid Overdose Attitudes Scale (OOAS) were used. The intervention was a skills-based learning activity with two segments, one that focused on naloxone counseling and the other focused on drug diversion. RESULTS: The aggregate mean change in KCES and OOAS scores of the cohort increased by 1.837 (P = .014) and 2.349 (P = .008), respectively. Of note, students with lower baseline empathy and attitudes scores showed more improvement in both KCES and OOAS scores. CONCLUSIONS: Students showed improvement in empathy and attitudes regarding opioid overdose and substance use disorder. A larger magnitude of improvement was noted with lower baseline scores.

Knowledge and self-perception comparisons between students with and without prior technician experience in community pharmacy lab courses.

INTRODUCTION: It is unknown if students with previous pharmacy technician experience benefit from a community pharmacy dispensing lab. Anecdotally, students with previous technician experience often do not feel a substantial benefit from the course. The purpose of this project was to evaluate pharmacy practice knowledge and perceptions of those with and without prior technician experience in a community lab course. METHODS: Doctor of pharmacy students enrolled in the lab course were included in the study. All students were administered a pre- and post-course self-perceptions survey and knowledge assessment (20 scenario-based multiple-choice questions). The knowledge assessment evaluated understanding of community pharmacy law, workflow, inventory, insurance, and prescription verification. Survey variables analyzed included length of experience, confidence, and course expectations. Results were analyzed using student's t-tests. RESULTS: A total of 216 students completed the pre- and post-assessments and were included for analysis. Students with previous technician experience scored statistically significantly higher on the knowledge assessment than students without experience (pre: 57% vs. 33%, post: 67% vs. 53%, respectively). Students without prior technician experience had many statistically significant increases in perceptions of knowledge and confidence, while those with prior technician experience had few. CONCLUSIONS: There is a baseline knowledge gap between students with technician experience and those without in a community pharmacy simulation lab. Results of this study have identified specific gaps which may be useful for course structure and design. This data supports investigation into 'testing out' or providing separate tracks in a community lab for experienced and non-experienced students.