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Please comment On My New Combo
Mar 27, 2004

Hi

I have been on Emtriva/Viread/Viramune (Once a Day)for a couple months now.

What is the latest on this combo?

Response from Dr. Cohen

The latest?

Well - there is not much to say specific to this combo - since as far as I know - this specific combo has not been in studies. There may have been some small trials over the years - but this specific combination is as far as I know not been a part of many recent studies. Nevertheless there are certainly reasons and ways to anticipate what we would see if we did do work on this combination. Which is that if someone is on this combination and feeling well and getting that viral load below detectable limits - it should be a good and valid combination that is likely to be able to maintain this suppression over time as well.

The US guidelines give us some general principles about combinations such as this one. For starting treatment - this combination would be based on meds largely considered "alternatives" to the "preferred" options. For nevirapine - that is based mainly on the safety differences between efavirenz and nevirapine - since there are some strict guidelines about who should and who should not start on nevirapine since the CD4 counts determine who may be at higher risk for severe liver damage. But after months of monitoring - if someone does not have liver toxicity from nevirapine - the longer term safety seems more assured. Unfortunately we don't have a lot of long term comparisons between efavirenz and nevirapine - up to one year in an important study called 2NN - the viral load suppression differences between these antivirals were small but favored efavirenz -- we cannot be totally sure if there are any additional differences in success rates after suppression on these two antivirals.

As for nucleoside pairs - viread / emtriva has been studied most recently in a study that added them to Kaletra - either once a day versus the more standard twice a day Kaletra. And both arms did fine - no concerns were raised for the success, potency nor safety of the viread / emtriva from this nor any other study. And viread is a component of one of the most successful long term studies we have called 903 - in which tenofovir provided long term safe suppression with very low rates of lipodystrophy noted even after three years (combined with epivir and sustiva).

The key is to ensure that your viral load gets suppressed to below detection on this (or any) combination - since if you do like this one - it will only last if your viral load is consistently suppressed to undetectable levels. It should work - but monitoring this is key -as is adherence to this combo. For most however - it should work fine. Just don't forget to have those liver tests done - just to be safe and thorough.

Hope that helps.



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