Question

Hi. When I first start my HAART regimen soon, I was wondering about taking Sustiva, Epivir, and Viread in their once a day formulations. Is this possible and advisable? Any con's? Also do any drug interactions with Sustiva lower metabolite levels of the Epivir or Viread? Any dosing adjustments?

Also how far away are we from getting more definitive treatment data on Viread?

I'm greatful for any thought and information.

Thank you!

Sean

Answer

Dear Sean- thanks for your questions.

There has been a wealth of new information on the first line combination of tenofovir/lamivudine/efavirenz (Viread/Epivir/Sustiva), with presentations at recent international meetings in San Diego and Glasgow (I'd refer you to the Conference coverage section of TheBody).

The regimen was not studied as an entirely once-daily combination, because of the double blinded nature of the study and because once-daily lamivudine was approved by the FDA at the time that the study began. Nonetheless, it is perfectly reasonable to think that the regimen can be used as a once-daily combo with similar, if not superior performance.

The regimen has been compared to the combination of stavudine/lamivudine/efavirenz and has shown similar virologic potency and excellent safety and tolerability with less toxicity (neuropathy) and lower cholesterol and triglycerides.

There are no significant drug-drug interactions between the three drugs (not true for combinations that use tenofovir and didanosine (Videx), so no dosing adjustments need to be taken.

As for new data, I suspect that Gilead, the maker of tenofovir will continue to provide updates of their landmark, three-year long GS-903 study at many of the upcoming international HIV meetings-- look for more data at the Conference on Retroviruses and Opportunistic Infections (Feb) and at the International AIDS Society Meeting (July).

Hope this is instructive- BY