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RE: Sustiva and Kaletra

Dec 29, 2003

I just wanted to say that Emtriva has recently been released allowing for a 36 hour regimen rather then epivir 24 Hour, Also I have heard from a recent study that Viread seems to be better and accessing latent infected areas, Doctors dont know why but it appears to be better at flusing this areas then other HIV meds.

Also, I noticed a lot of postings regarding Sustiva. And allthough I think it is an incredible drug I am not sure why more people dont explain the consequences of not adhering to this particular drug since one mutation and the drug is gone. It would seem more warning would be given on this particular drug since it is more suseptible to mutations then almost all others, While Kaletra on the other hand is extremely hardy and needs several mutations and then typically it becomes less effective but does have some effectiveness.

Response from Dr. Pierone

Emtriva (emtricitabine, FTC) is similar to Epivir (lamivudine, 3TC) in its potency and like Epivir a single viral mutation, M184V, leads to high level resistance. Emtriva has a longer persistence in the body than Epivir and may be more forgiving (in terms of developing resistance) in case a dose is missed. I have not heard about Viread (tenofovir) being better at accessing latent virus, but from a practical standpoint virtually all recommended combination regimens appear to reach virus in sanctuary sites.

We preach (fire and brimstone) all day long about the consequences of non-adherence because of the fragility of antiretroviral medications. Not only is Sustiva gone if a single mutation develops, but resistance to Viramune (nevirapine) and Rescriptor (delavirdine) appears as well.

Kaletra is quite different in terms of resistance. One of the reasons that HIV doctors prescribe Kaletra instead of Sustiva (or Viramune) for some patients is because it is much hardier and less prone to fail as a result of resistance. A truly remarkable observation is that there has yet to be a case of viral resistance to Kaletra in patients that have started it in first line therapy or even as first protease inhibitor. Even in the Kaletra monotherapy trials (link) there has yet to be a case of resistance found. Gee, why isn't everyone on Kaletra then? The reason has to do with more pills and more side effects. The regimen is 3 pills twice daily (compared to one pill daily for Sustiva), urgent type diarrhea in some people, increased cholesterol and triglyceride levels, and risk of insulin resistance and diabetes. Of course, because these effects may happen does not mean that they are going to, and many people take Kaletra without any discernable problems whatsoever.

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