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3 drug combo (videx EC 250mg, viread 300mg, viramune 200mg) once a day

Jun 28, 2002

What is your opinion of a 3 drug combo? My VL is 53,000, my CD4 is 380 I believe! The combination is 4 pills once a day after a meal. 1-videx EC 250mg, 1-viread 300mg, and 2-viramune 200mg. Please let me know your opinion of these drugs and any knowledge you have to share would be greatly appreciated!

Response from Dr. Young

Thanks for the question.

The combination of ddI/tenofovir/viramune certainly is a very attractive, probably well tolerated, once-a-day regimen. There are a number of unknowns with the regimen-- in particular, the issues about ddI levels when co-administered with tenofovir. Recent studies with the conventional 400 mg dose of Videx EC taken with tenofovir showed roughly 60% increases in ddI levels. It stands to reason that using the lower, 250 mg dose of ddI should offset this increase. However, no data currently gives us the confirmation of this point. Since higher ddI levels might portend higher rates of side effects and complications, like neuropathy, I'd proceed with cautious monitoring.

Also, the pattern of drug resistance following failure of ddI/tenofovir has not been explored, nor reported. One concern could be the generation of virus that might be resistant to many of the other nucleoside inhibitors that I'd want to use in a second-line treatment regimen.

Despite these concerns, the regimen should be very potent and well tolerated. Many practioners are using this as one of their preferred first line regimens, even in the face of no prospective studies about the performance of the combination.

Allowing for your understanding of these limitations, it seems very reasonable to me. Let us know how it goes. -BY

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