September #84 : Our Daily Med - by Mike Barr

POZ - Health, Life and HIV
Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:

Back to home » Archives » POZ Magazine issues




Table of Contents

This Face has a Message for the World

Lines Composed in a Looking Glass

The Problem with Protease

Lipo: The Latest

Parent Trap

What's Life Worth?

ADA R.I.P.?

Wind Beneath Their Wings

Fuzzy Math:

Double Deal:

Getting Snippy

Creature Features

Clit Club

Con:

Safe Sucks:

Our Daily Med

Thymouse?

Run Interference

Look, Ma, No KS!

Warts Up, Doc?

Thai Clip:

Only Connect:

False Alarm:

Tribute: Linda Grinberg

Bayou Blues

Milestones:

Heroes

Mailbox

Back to Basics

Publisher's Letter



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


email print

September 2002

Our Daily Med

by Mike Barr

Imagine popping two tiny pills in the morning -- and going on with your day, your chemical shield against HIV intact for the next 24 hours. Sounds like a fantasy, but with the ballooning number of once-a-day HIV meds, this dream is fast coming true. But some skeptics are wondering about this so-called emperor's new clothes.

One-a-day is already the standard for efavirenz (Sustiva), ddI (in its Videx EC form) and tenofovir (Viread). And some researchers argue that the typically twice-daily 3TC (Epivir) and nevirapine (Viramune) are safe and effective "qd" (or quaque die, Latin lingo for once a day). Then there's the trend toward boosting protease inhibitor (PI) levels with ritonavir (Norvir), which allows almost any PI to become a qd, and the number of potential once-daily regimens doubles.

While this brave new world of a single pill has yet to dawn, there are now several qd regimens consisting of a mere three or four pills -- all easy to tolerate and low on toxicity. Once Bristol-Myers Squibb's once-daily d4T (Zerit XR) and its once-a-day protease atazanavir (Zrivada) get to market -- likely in the next year -- the potential for qd combos swells (see "Once-Daily Doses," below).

Now, about that naked emperor: Adherence troubles sparked the quest for once-daily regimens. But it's not entirely clear that compliance actually improves when a twice-a-day regimen is replaced with a qd.

In a giant cross-study analysis of pill-poppers with chronic diseases such as diabetes, there was only a tiny difference in adherence rates between twice-a-day and once-daily regimens -- although the difference between three times vs. once daily was huge.

ONCE-DAILY DOSES

FDA-Approved
Agenerase with Norvir (PI)
Sustiva (NNRTI)
Videx EC (NRTI)
Viread (NtRTI)

Pending Research/Approval
Epivir (NRTI)
Fortovase with Norvir (PI)
Viramune (NNRTI)
Zerit XR (NRTI)
Zrivada (PI)

Skeptics also point to a treatment-simplification study by GlaxoSmithKline. After their viral loads went below 50 on a PI/two nuke combo, half of the volunteers were switched to Glaxo's Trizivir (abacavir/AZT/3TC). "With a single tablet morning and night, what could be easier?" Glaxo asked rhetorically -- and then got an answer it didn't much like. Only 60 percent of those on the protease combo reported perfect adherence, but the Trizivir-takers did only slightly better: Fewer than three-quarters reported complete compliance.

Then there's the "forgiveness" factor: the tricky question of whether HIVers risk sacrificing reliable drug levels for the convenience of simple dosing. ddI, Viread, Sustiva? No problem. Miss a dose and the stuff's still floating around in your blood a few days later. But the other qd drugs are far less generous with their time.

In a recent Treatment Issues, the GMHC newsletter, editor Bob Huff lampooned BMS' efforts to reassure queasy qd wannabes, recalling how at last February's Retrovirus confab, BMS researchers showed that twice- and once-daily pills were equally effective for 24 hours -- but were conveniently silent about what happens after that. After all, with once-daily meds, a skipped dose could leave 48 hours between pills -- and that would dump you in a data no-man's-land.

We're all eager for simpler pill-popping schedules, but the moral of this story is, HIVers should keep one eyebrow raised as the new crop of once-a-day therapies springs up this fall, and after.




[Go to top]

Join POZ Facebook Twitter Google+ MySpace YouTube Tumblr Flickr
Quick Links
Current Issue

HIV 101
HIV Testing
Safer Sex
Find a Date
Newly Diagnosed
Disclosing Your Status
Starting Treatment
Search for the Cure
POZ Stories
POZ TV
Read the Blogs
Visit the Forums
Women
African American
Latino
Providers
Job Listings
Events Calendar


    aqua_31206
    Macon
    Georgia


    newlife202
    JOLIET
    Illinois


    cortaza100
    Chicago
    Illinois


    RayOctober
    Richmond
    Virginia
Click here to join POZ Personals!
Ask POZ Pharmacist

Talk to Us
Poll
Can social media help stop HIV stigma?
Yes
No

Survey
Mind Matters

more surveys
Contact Us
We welcome your comments!
[ about Smart + Strong | about POZ | POZ advisory board | partner links | advertising policy | advertise/contact us | site map]
© 2014 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.