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Once-Daily Medicines for HIV Disease

Summary & Participants

The treatment of HIV can be very complex with medicines that have to be taken several times a day. Now there are medicines that can be taken once a day. Learn how doctors are striving to make the treatment of HIV more manageable.

Medically Reviewed On: May 08, 2008

Webcast Transcript

DAVID L. BUTCHER, MD: When I talk to new patients about HIV treatment, and I tell them that they can take a few pills once a day, they're ecstatic.

ANNOUNCER: That's because until recently, people with HIV didn't have treatment options that were so simple.

BRIAN BOYLE, MD: The regimens we used to give patients could be extraordinarily complicated. For example, some pills you would take on an empty stomach and they would have an interaction with another pill that you also had to take on an empty stomach but had to be taken separately from the other pills. And then other pills that you may have given had to be taken on a full stomach.

So, in some respects, with some of these regimens we used to give patients, they needed a computer algorithm to keep track of when they were supposed to take it and how they were supposed to take it. And you can imagine trying to do that every single day of your life.

ANNOUNCER: And when patients find it difficult to take each and every dose, that's a very serious problem.

GARY COHAN, MD: Compliance is the issue these days, and it turns out that much to our chagrin you have to be near perfect in compliance. You have to be 95% compliant or better. That means out of 20 doses, you definitely have to get 19 doses in, or you will likely become resistant to the medications. And that's difficult.

ANNOUNCER: But for many people, taking HIV medications is now much easier. All three of the main classes of antiretroviral drugs have approved, once-a-day options.

BRIAN BOYLE, MD: Well, the first drug that was approved for once-a-day was in the non-nucleoside class, Sustiva. Later, we had drugs in the nucleoside analog class approved for once-a-day, including Videx EC, Viread, Epivir and Zerit XR.

And in the protease inhibitor class, approved for once-daily use is Agenerase with Norvir-boosting. And recently approved is Reyataz, which is a once-a-day medication that is given generally without Norvir-boosting.

There are a bunch of other drugs that can be used once-a-day, including Viramune, which achieves good blood levels throughout the 24-hour period. And also abacavir, which also appears to achieve adequate levels to support once-a-day. Although those aren't formally approved for once-a-day, many clinicians use them once-a-day.

GARY COHAN, MD: In patients who have never been on an antiviral therapy, I think for the vast majority of those patients at least 70 or 80% of those patients, there are probably going to be good once-daily options available.

ANNOUNCER: Many times, even people doing well on more complicated regimens can switch.

GARY COHAN, MD: We have many patients who were started on good twice-daily drug regimens or even three-time-daily drug regimens several years ago. They're not complaining. They're viral loads are undetectable. But, that was then and this is now. And we have better therapies, and as therapies evolve I think it's important to simplify the therapy for the patient to again decrease the likelihood or the odds of a patient becoming resistant because of missed doses. So I'm a big advocate of treatment simplification, if possible, to once-daily.

ANNOUNCER: Once-daily HIV drugs, like all medicines, have side effects. These can include nausea, rashes, dizziness or problems sleeping, problems with the liver and pancreas, and acid build-up in the blood. But doctors say these are generally mild and that most patients can tolerate the drugs.

BRIAN BOYLE, MD: The side effects that you commonly see with these drugs are generally manageable. And again, most of them are self-limited, which means that, given a little bit of time, they tend to go away on their own.

ANNOUNCER: HIV therapy is highly individualized. And while once-daily medications are not for everybody, they are very valuable for many people.

DAVID L. BUTCHER, MD: I think there are some people where doing more than taking a few pills when they get up or a few pills at bedtime is going to be near impossible, and thus, for those people, they can now get great success from their regimen with viral load suppression, CD4 increases, much better health and they can do it. It's not going to fix it for everybody, but it's clearly had an impact on a number of people.

GARY COHAN, MD: We're going to save lives because we've gone to once-daily therapy. When you have to dose medications multiple times a day, there are very few patients who can sustain that very rigorous dosing regimen for the long haul. So on a chronic manageable disease basis, we're going to save a lot of lives with once-daily therapy.