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Adding Viread to a working regimen
Apr 13, 2004

Hi,

I have been positive for over 12 years, and started my first antiretroviral regimen 13 months ago. I am currently on Videx EC, Sustiva, Epivir (150mg 2 times a day). Essentially, I take my Videx EC and 150mg Epivir in the a.m on an empty stomach and take the Sustiva and 150mg of Epivir (2nd daily dose) in the p.m. My most recent labs are as follows: Viral load undetectable. CD4 402, (17) (My viral load became undetectable approx. 7 mos. after starting therapy) My Dr., a well-known HIV specialist, is recommending to add Viread to my current regimen, and also to switch out the Epivir for Emtriva, which he says has a longer half-life. I expressed my concern about adding a 4th drug. (Viread). I have not read anything recommending 4 drugs for someone on their 1st regimen, and that since the current regimen seems to be working why add another potentially toxic drug?. I also asked about what would happen if this new regimen fails, he said then I would be put on 2 protease inhibitors and also T-20. I have heard that T-20 is very expensive and hard to tolerate due to mulitple daily injections. He said that adding the Viread and switching to Emtriva would increase my chances of better immune reconstitution, etc. (I have always been asymptomatic and am tolerating the current regimen without any side effects) Does this make sense to change drugs when the current ones seem to be working? I have been with this Dr. for 10 years and respect his expertise, but would like a second opinion.

Thank You.

Response from Dr. Pierone

The plan of action outlined goes a bit beyond the current standard of care. There is a theoretical potential to lower the longer risk of virologic failure with a 4 drug regimen, but this has not been proven. There are a number of 3 drug versus 4 drug studies that are ongoing and will shed some light on these issues in the near future. If a potent 3 drug regimen is working (and yours certainly is), then adding a 4th agent will certainly increase cost and potentially increase toxicity.

I wonder why you just don't take all of your medications together in the evening on an empty stomach? They all are approved for once daily use and Epivir comes in a 300mg tablet now. So Sustiva 600mg, Epivir 300mg, Videx EC (250 or 400mg depending on body weight) is a 3 pill, once daily regimen that works quite well.

Videx EC is a good medication and certainly less toxic than previous formulations of ddI. My main concern with this agent is the rare, but sometimes severe (i.e.fatal), pancreatitis that may occur with treatment, even in those that have been taking it for years. Viread has a lower risk of pancreatitits and peripheral neuropathy which is probably why it is used more commonly. If you were interested in tweaking your regimen, a single-agent switch of Videx EC for Viread has some appeal for these reasons.

Thanks for posting and best of luck.



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