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pill burdern, a definitive answer
Mar 28, 2001

Dr. Boyle:

Can you tell me, definitely, what my options are for the least number of pills in a powerful/potent, once-a-day, or as close to once-a-day combination for therapy. For example I know Videx has a new once a day and Sustiva as well. Can I take these together? Are there others?

33, male, sero-positive 5/6 years. treatment naive, but my NYC doctor is impressing me to start theray as my numbers are in delcine; VL 97,000 copies, CD4, 580.

Maintain a very erratic work/life schedule and need something, strong, w/few side effects that is easy to take.

Thanks in advance for you time.

Response from Dr. Boyle

There are several potential once-daily regimens using the medications currently FDA approved; however, to this point only two drugs have been FDA approved for once-daily therapy. The NRTI "backbone" would consist of Videx or Videx EC (didanosine, ddI) and Epivir (lamivudine, 3TC), since these drugs have long intracellular half-lives. These would be combined with either a non-nucleoside, Sustiva (efavirenz) or Viramune (nevirapine), or a ritonavir-boosted protease inhibitor. Videx, Videx EC and Sustiva are FDA approved for once-daily therapy. The other medications mentioned above are not yet FDA approved for once-daily dosing, but there is some phamacologic and limited clinical evidence supporting once-daily dosing of these drugs or drug combinations. The simplest, most tolerable, most forgiving, and best studied once-daily regimen is Sustiva + Videx + Epivir, and recent data presented at the 8th Retrovirus Conference supported the use of this regimen. If I was going to start a patient on a once-daily regimen at this point, this is the one I would choose. There are also several clinical trials evaluating once-daily therapy, and if you are eligible you might consider one of those. Discuss this issue with your doctor and get his or her advice before pursuing any of the regimens discussed, and keep in mind that we still have only 2 drugs that have been FDA approved for once-daily dosing. In the next couple of years, options for once-daily therapy will increase as new formulations of current drugs become available, e.g., extended release Zerit, and new, once-a-day drugs are approved, e.g., BMS 232632 (a true once-a-day protease inhibitor) and tenofovir (a nucleotide reverse transcripatase inhibitor). BB



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