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Viread in combo
Aug 30, 2002

Dr.,

From what I have read, Viread sounds like a good option for my first attempt at treatment. My doctor has never prescribed it before and doesn't know much about it. Should I just stick with what he knows? What would a good combination be including this drug?

thank you!

Response from Dr. Wohl

If tenofovir came out 6 years ago, it would probably be one of the most commonly used antiretroviral on the planet. Instead, as a newcomer, it must prove itself against the likes of older, more established drugs like AZT, d4T and ddI.

Clinicians often get set in their ways and are reluctant to try something new unless there is a clear justification for vearing from the familiar. The first evidence that tenofovir was a potent and well tolerated agent came from studies where it was used as a salvage or 'last ditch effort' therapy. Treaters have become more accustomed to using the drug in this situation.

Only recently have data emerged demonstrating the drug can be used as a first line agent with just as much success as one of the most common combos out there (d4T/3TC/efavirenz). The major study comparing tenofovir to d4T when combined with these other two drugs was designed to show whether or not the combos tested were similiar in effectiveness and not to see how much better one was over the other. I think over time this study may show that not only is tenofovir at least as potent and effective as d4T but that it may end up having less toxicity.

I think tenofovir is a very reasonable choice as a first line agent and given the data regarding the potency of 3TC and efavirenz (and that all can be given once a day) see this as a nice combination for someone starting on therapy. Good luck-DW



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