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Videx/Viread/Sustiva
Feb 6, 2003

I wrote to you twice before regarding correct dosage and timing of Viread/Videx. After speaking directly with the manufacturer of Viread and getting your response..including speaking with my doctor, I received my prescription of Sustiva, Viread, and Videx EC 250MG. I just took them for the first time tonight. I have to admit I am very scared, so I am typing this maybe just to clear my mind. I guess the point that still has me concerned is the timing of when to take them. I intend to take them all together at 11:00PM, about 2-4 hours after and meal (not to mention I go to the gym between 8:30 and 10:30pm). Viread is suppossed to be taken with a meal due to its absorption (according to labels). When I called the manufacturer, they stated that the data indicates it should be OK to take them without all without a meal, but she was a little apprehensive and asked it I could take the Viread with a meal. I stated that defeats the purpose of a once a day regimen. She then stated I would probably do OK. That didn't make me feel very confident. My doctor stated he was not concerned with the timing I choose since I would have eaten throughout the day (though I don't understand what this has to do with anything, as I thought two hours means empty stomach). I read a study that stated that Viread was given to HIV- and HIV+ people, and the half-life was greater in HIV- people as compared to HIV+ people. The study didn't elaborate on the tcells or history of the HIV+ folks. In my opinion, putting all HIV+ people in one bucket is wrong, as the line that one falls on (Tcells, resistance, immune function, ect) can vary so greatly. Can you please explain to me why you feel comfortable stating that Videx and Viread can be taken together without regard to meal? I guess I would feel more comfortable if you could elaborate further. In the meantime, I am going to close my eyes and try to go to sleep. In 5 weeks, my doctor will take a blood test which will hopefully show continuing good progress. Thanks for your patience with me.

Response from Dr. Young

Thanks for your follow up.

You raise all good points; really there is not a lot of data about the drug concentrations, nor performance of this combination among HIV-infected individuals. Hence, there is a degree of speculation to all that we say about ddI/tenofovir/efavirenz; at least until the studies are actually done.

As for the dietary issue; there is some data that says that tenofovir levels go up with meal ingestion- the effect is not huge, and might matter for persons with virus that had some reduction in susceptibility (drug resistance). If one is most concerned about the possibility of a negative effect, a way to deal with this is to take the pills (all together) with a small snack.

Either way, it will be your blood tests and viral load reductions that will tell us how this drug regimen works for you (not just some other study patient). The combination should be very potent, therefore and small reductions in drug levels probably won't result in any negative effects.

Let us know how things go for you, and thanks for the follow up. -BY



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