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Need simple drug therapy plan
Jul 7, 2003

Dr,

i want to start treatment but wish to start on a therapy that is easy to take and simple with few dosing periods and number of pills.

i travel a lot in different time zones and also wish not to disclose my HIV status to my co-workers. please help me find a combination therapy that will fit with my lifestyle.

thank you.

Response from Dr. Pierone

So you want simple, ok, here it is. There has been a major trend in treatment of HIV infection favoring the use of once daily therapy of HIV infection. What could be easier? Well, once monthly would be easier, but we are not there yet.

What is available now are regimens in which one can take all the medications together in the morning with breakfast, or before bed, or at lunchtime, or with afternoon tea - whatever works best for your lifestyle.

Medications that can be used once daily include Viread, Epivir, Viramune, Sustiva, Videx EC, and Ziagen. Not all of these are FDA approved for once daily use, but all have clinical data supporting their use once daily. Just approved once daily medications are Reyataz (atazanavir new protease inhibitor) and Emtriva (emtricitabine FTC new nucleoside). So as you can see we now have an abundance of HIV medications that can give given once daily.

The tricky part is deciding which ones to use first and how to combine them taking into account their interactions and side effects. Most HIV treating doctors in the U.S. choose either Sustiva or Viramune (non-nucleoside reverse transcriptase inhibitors NNRTIs) as the linchpin medication for treatment-nave patients. Same thing in Australia, although in South America protease inhibitors are used up front more commonly. NNRTIs are considered important in a regimen because studies have shown superior results compared to triple nucleosides (such as Trizivir) and non-boosted protease inhibitors (such as Viracept).

If one uses Sustiva or Viramune (see 2NN study equal effectiveness, different side effects) as the linchpin, the other 2 medications to combine for a once daily regimen are chosen from the above list. Often Viread and Epivir are used together, but that may change with the introduction of Emtriva since it is produced by the same company that makes Viramune. Videx EC and Viread are used together commonly, but the dose of Videx should be adjusted downward to account for an interaction. Ziagen and Epivir and being combined into one pill for once daily use in the future, but are used together now as separate agents.

This may all change with the introduction of Reyataz, the new protease inhibitor. It does not seem to possess the negative metabolic side effects of other protease inhibitors and is 2 pills once a day. Time will tell with both Reyataz and Emtriva how well they are accepted by doctors and patients, but both seem very promising.

This may have confused more than helped, but suffice it to say there are ample options for a once a day, simple regimen and the details can be worked out with guidance from your doctor. Good luck!



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