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Nucleoside Reverse
Transcriptase Inhibitors
HIV uses what is called a Transcriptase Enzyme in order to copy its own genetic code into healthy genetic material. NRTIs prevent this by not letting it create a bind with the healthy cell and thus prevents the cell from being able to duplicate.

TRUVADA

(Emtricitabine/Tenofovir)

DHHS Status: Recommended

Manufacturer: Gilead Sciences (www.gilead.com) Truvada (www.trivada.com)

FDA approval date: August 2, 2004

Financial Assistance: https://www.truvada.com/truvada-patient-assistance

Each Truvada tablet contains 200mg of Emtriva (emtricitabine) and 300mg of Viread (tenofovir). Standard dose is one capsule a day and can be taken with or without food.

Review:Truvada is an outstanding combination drug that allows you to take two-thirds of your drug regimen in one pill, taken once a day. Truvada is the NRTI (Nuke) component in both Atripla (where it is combined with Sustiva) and Complera (where it is combined with Edurant). Truvada is also the NRTI component of Striblid. As a stand-alone drug, it is considered “Recommended” by the latest DHHS guidelines. A new, reformulated version of Truvada, substituting tenofovir alafenamide (TAF) for tenofovir disoproxil fumarate (TDF), was approved last year and is Descovy (see next) and is also DHHS “Recommended” for use in first line therapy. Less kidney and bone issues are present with TAF than TDF in clinical trials. The Truvada to Descovy reformulation is Gilead Science’s third reformulation using TAF in place of TDF.

Truvada For PrEP

Truvada was approved by the FDA in July of 2012 for HIV prevention – Pre-exposure Prophylaxis (PrEP) used by people who are currently HIV-negative. Clinical studies showed that HIV-negative individuals who took Truvada for PrEP everyday and who combined it with condoms (and other HIV prevention methods) can see their HIV risk cut considerably. This is true for both women and men for both vaginal and anal sex. The reformulated, Descovy has not been approved for PrEP use. Unlike using Truvada for HIV treatment, using Truvada for PrEP can be used for short periods of time when a HIV-negative individual might be at risk for exposure. Truvada for PrEP takes about 7-days to reach protective levels in the rectal tract and about 21-days to reach protective levels in the vaginal tissue. For more information on Pre-exposure Prophylaxis (PrEP) consult your physician and go to www.truvadapreprems.com. Lactic Acidosis (a build-up of acid in the blood) is a potential side effect and persons with kidney disease may not be candidates to use Truvada.

Truvada is a fantastic and multifaceted drug.


DESCOVY

(Emtricitabine/Tenofovir Alafenamide)

DHHS Status: Recommended

Manufacturer: Gilead Sciences (www.gilead.com) Descovy (www.descovy.com)

FDA approval date: April 4, 2016

Financial Assistance: https://www.gileadadvancingaccess.com

Each Descovy tablet contains 200mg emtricitabine and 25mg tenofovir alafenamide. Descovy is indicated in combination with other antiretroviral agents for the treatment of HIV infection in adults and pediatric patients 12 years of age and older. Descovy is not indicated for use as pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV in adults at high risk.

Review: Descovy is Recommended in current DHHS guidelines. The newest of all the approved drugs, being approved last April and as the first new HIV treatment backbone approved by the FDA in more than a decade, Descovy represents an important evolution in HIV care. As part of a single tablet regimen or partnered with a third agent, the components of Descovy offer a simple and effective combination with a safety profile that has the potential to improve health.

Descovy is the third and newest drug that Gilead Sciences has offered recently that is reformulated using Tenofovir Alafenamide (TAF) rather than Tenofovir Disoproxil Fumarate. Basically, it is a reformulation of the DHHS “Recommended” and extremely successful drug Truvada.

TAF has demonstrated improvement in surrogate laboratory markers of kidney and bone safety as compared to TDF in clinical trials in combination with other antiretroviral agents. Data show that because TAF enters cells, including HIV-infected cells, more efficiently than TDF, it can be given at a much lower dose and there is 90 percent less tenofovir in the bloodstream.


EMTRIVA

(Emtricitabine)

DHHS Status: Recommended in combo

Manufacturer: Gilead Sciences (www.gilead.com) Emtriva (www.gilead.com)

FDA approval date: July 2, 2003

Financial Assistance: https://www.gileadadvancingaccess.com

The standard dose of Emtriva is one 200mg pill once a day. With or without food.

Review: Emtriva is an extremely popular and effective drug. It is also very easy to tolerate. It is usually not prescribed for use by itself however, Emtriva is combined with Viread to form the combination drug Truvada and is also combined to form Descovy (see prior). Truvada is a DHHS “Recommended” combination NRTI for first time therapy and was also approved in July of 2012 for HIV prevention Pre-exposure Prophylaxis (PrEP) for HIV negative individuals. For more information on PrEP, go online to www.truvadapreprems.com. Descovy is also DHHS “Recommended” for first time therapy although is not approved for PrEP.

Emtriva is a component of single-tablet regimens (see SRTs section) Atripla, Complera, Genvoya, and Stribild.

Emtriva is also effective against Hepatitis B although should not be used for treatment of Hepatitis B alone only in combination of HIV treatment.


VIREAD

(Tenofovir Disoproxil Fumarate)

DHHS Status: Recommended in combo

Manufacturer: Gilead Sciences (www.gilead.com) Viread (www.viread.com)

FDA approval date: October 26, 2001

Financial Assistance: https://www.gileadadvancingaccess.com

Viread comes in 300mg tablets. Standard dose is one tablet, once a day. It can
be taken with or without food.

Review:Viread is considered a “Recommended” drug in the current DHHS guidelines. It is a very popular drug and, as with Emtriva, is used as a combination in Truvada, Atripla, Complera, and Stribild. The combination with Emtriva in Truvada was approved by the FDA in July of 2012 for HIV prevention Pre-exposure Prophylaxis also known as PrEP in HIV negative individuals. For more information on PrEP, go online to www.truvadapreprems.com.

Viread is also approved by the FDA for Hepatitis B therapy.

Viread is technically a Nucleotide Reverse Transcriptase Inhibitor but it is similar to the Nucleoside Reverse Transcriptase Inhibitors so we have grouped it in (as most do) here.

Gilead Sciences has been replacing Viread (tenofovir disoproxil fumarate- or-TDF) with Tenofovir Alafenamide Fumarate-or-TAF which is shown to have lower rates of kidney and bone disease when compared to Viread. Genvoya was the first single-tablet regimen to contain TAF rather than TDF, and Odefsey is the second (see both in STR section). The third is a reformulation of Truvada that is Descovy (see previous).


EPZICOM

(Lamivudine/Abacavir)

DHHS Status: Recommended in combo, otherwise alternative

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Epzicom (www.epzicom.com)

FDA approval date: August 2, 2004

Financial Assistance: https://www.viivhealthcareforyou.com

Each Epzicom tablet contains 300mg of Epivir (lamivudine) and 600mg of Ziagen (abacavir). The standard dose is one tablet a day.

Review:Epzicom is a combination drug, which like Truvada, allows you to take two-thirds of your three-drug regimen in one pill and is a Nucleoside Reverse Transcriptase Inhibitor or “Nuke.”

The current DHHS guidelines list Epzicom as an “Alternative” drug to the “Recommended” drug Truvada because of concerns of cardiovascular risks in studies and because in another study persons did not do as well when they started at a higher viral load – greater than 100,000 copies/mL. Epzicom is a good alternative to Truvada currently however, because it is very useful to persons who have kidney problems.

Epzicom was given FDA approval on August 22, 2014 in combination with Tivicay (Dolutegravir) - which is an Integrase Inhibitor approved by the FDA in August of 2013 as a stand alone drug - as the single tablet regimen drug, Triumeq. Epzicom is listed in DHHS guidelines as a “Recommended” drug when paired with Tivicay.

Before using Epzicom, there is a test that must be taken that predicts who may be allergic to Ziagen. The test is called HLA-B*5701. Epzicom is considered a good drug for those who test negative for HLA-B*5701. Those who test positive for HLA-B*5701 should not take Epzicom.


EPIVIR

(Lamivudine)

DHHS Status: Recommended in combo, otherwise alternative

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Epivir (www.viivhealthcare.com)

FDA approval date: November 17, 1995

Financial Assistance: https://www.viivhealthcareforyou.com

Recommended dose is one 300mg tablet once a day or one 150mg tablet twice a day. You can take it without regard to meals.

Review: Epivir is an older yet still important part of combination therapy today although it is not considered to be quite as good as its newer rivals Emtriva and Viread. It is very tolerable. Epivir is one of the ingredients in Combivir, Trizivir and Epzicom. Epivir has been combined with Ziagen and Tivicay in the single tablet regimen Triumeq that was approved in August of 2014 year and is “Recommended” as an initial therapy in the current DHHS guidelines. Epivir is available in generic form and also approved by the FDA for Hepatitis B therapy.


RETROVIR

(Zidovudine)

DHHS Status: Not recommended, other

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Retrovir (www.viivhealthcare.com)

FDA approval date: March 19, 1987

Financial Assistance: https://www.viivhealthcareforyou.com

Comes in 100mg and 300mg capsules, 10mg/mL IV solution and 10mg/mL oral solution. Recommended dose is 200mg (two 100mg capsules) three times a day or 300mg (one 300mg capsule) twice a day. You can take it without regard to meals.

Review: Retrovir was the very first drug found to be effective against HIV – and it’s still effective though rarely prescribed by itself anymore because of easier and better-tolerated regimens available today. However, it is still considered a main medication for women who are pregnant and for infants after birth. In the early days (when it was usually called AZT) it had a bad reputation because it was often given in excessively high doses and because it didn’t work for long by itself – nothing does! Now, they have the appropriate dosing figured out. Retrovir is an ingredient in both Combivir and Trizivir.


COMBIVIR

(Lamivudine/Zidovudine)

DHHS Status: Not recommended, other

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Combivir (www.viivhealthcare.com)

FDA approval date: September 27, 1997

Financial Assistance: https://www.viivhealthcareforyou.com

Each Combivir tablet contains 300mg of Retrovir (zidovudine, AZT) and 150mg of Epivir (lamivudine). Recommended dose is one tablet, twice a day. Combivir can be taken with or without regard to meals.

Review: Combivir was approved by the Food and Drug Administration (FDA) in 1997, so it has been around for a long time. More clinical trials have used Combivir, in combination with various other medicines, than any other HIV drug. The generics Lamivudine and Zidovudine were made available in 2012.

Combivir was downgraded in the DHHS guidelines from an “alternative” drug due mostly to the twice-daily dosing as compared to the once-daily alternatives and also the fact that Truvada and Epzicom are better tolerated with less side effects.

Combivir, however, is still recommended over Truvada for women who are pregnant.


ZIAGEN

(Abacavir)

DHHS Status: Recommended in combo

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Ziagen (www.viivhealthcare.com)

FDA approval date: December 17, 1988

Financial Assistance: https://www.viivhealthcareforyou.com

Comes in 300mg tablets and 20mg/mL oral solution. Recommended dose is 300mg (one tablet) twice a day. You can take it without regard to meals.

Review: Ziagen is a well-tolerated drug with few side effects, although Ziagen carries with it the risk of hypersensitivity reaction, which occurs in about 5% - 8% of people. A simple blood test, however, HLA-B*5701 can screen for this potential to see if you may or may not be at risk. Ziagen is one of the ingredients in both Trizivir and Epzicom. Ziagen is also an ingredient (along with Epivir and Tivicay) in the single tablet regimen drug Triumeq, and is considered a “Recommended” drug.


TRIZIVIR

(Abacavir/Lamivudine Zidovudine)

DHHS Status: Not recommended

Manufacturer: ViiV Healthcare (www.viivhealthcare.com)
Trizivir (www.viivhealthcare.com)

FDA approval date: November 14, 2000

Financial Assistance: https://www.viivhealthcareforyou.com

Trizivir is a combination of three HIV medicines. Each Trizivir tablet contains 300mg of Retrovir (zidovudine, AZT) 150mg of Epivir (lamivudine) and 300mg of Ziagen (abacavir). The recommended dose is one tablet, two times a day. It can be taken with or without a meal.

Review:Trizivir was an early attempt to put a complete, three-drug HIV cocktail into a single pill. It was good for it’s day but it’s day has passed and it’s just not as good as the more recent versions.


VIDEX EC

(Didanosine)

DHHS Status: Not recommended

Manufacturer: Bristol-Myers Squibb (www.bms.com) Videx EC (www.bms.com)

FDA approval date: October 19, 1991 (Videx), October 31, 2000 (Videx EC)

Financial Assistance: N/A

Videx EC comes in 400mg enteric coated capsules. Recommended dose is one capsule, once a day. Take on an empty stomach one hour before or two hours after food or drink.

Review: Videx EC is rarely if ever prescribed anymore. Videx was an early HIV medicine. However, it was destroyed by stomach acid so a strong buffering agent was used, which caused stomach upset and drug interaction problems. Videx EC is “enteric coated” which eliminated most of the stomach problems, still, Videx has been eclipsed by newer and better drugs available today.


ZERIT

(Stavudine)

DHHS Status: Not recommended

Manufacturer: Bristol-Myers Squibb (www.bms.com) Zerit (www.bms.com)

FDA approval date: June 24, 1994

Financial Assistance: N/A

Comes in 15, 20, 30 and 40mg capsules and 1mg/mL oral solution. Recommended dose for people weighing more than 132 pounds is 40mg twice a day. Recommended dose for people weighing less than 132 pounds is 30mg twice a day.

Review: Zerit has been around for a long, long time. It is not used much anymore at all because of its many toxic side effects and because there are many better alternatives.


Single Tablet Regimens

Protease Inhibitors

Nucleoside Reverse Transcriptase Inhibitors

Non-Nucleoside Reverse Transcriptase Inhibitors

Fusion Inhibitor

Entry Inhibitor

Integrase Inhibitor

Pharmacokinetic Enhancer




 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Copyright 2017, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!