"Reverset appears to be an excellent addition to our armamentarium of
nucleoside reverse transcriptase inhibitors. It is well tolerated and active against virus with various mutations," he said.
However, while we know resistance can slow this virus down--we all know resistant virus can win; look at what happened in the era of treating with just
nucleoside reverse transcriptase inhibitors (NRTIs) and the ongoing deaths from uncontrolled HIV.
Newer drugs are selecting for different types of resistance, especially in
nucleoside reverse transcriptase inhibitors (NRTIs), so that there may not be large numbers of thymidine analog mutations (TAMs) developing in patients who have started therapy in recent years.
The randomized study of 122 patients with HIV added a protease inhibitor to a standard regimen of two
nucleoside reverse transcriptase inhibitors and one nonnucleoside reverse transcriptase inhibitor for 62 patients who continued the induction regimen for 24-32 weeks in order to lower viral load to less than 50 copies/mL.
Also, among patients on multiple
nucleoside reverse transcriptase inhibitors, platelet counts of less than 99,000/m[m.sup.3] (OR 2.40), creatinine greater than 1.5 times the upper limit of normal (OR 2.60), and use of concomitant hepatotoxic medications (OR 1.46) were associated with severe hepatotoxicity.
Surprisingly, support for this notion has come from testing the effect of removing single drugs from a failing regimen--in particular,
nucleoside reverse transcriptase inhibitors (NRTIs).
The most common resistance was to
nucleoside reverse transcriptase inhibitors (6.2% of specimens).
Each dose of Trizivir is a fixed-dose combination of Ziagen (abacavir/ABC), Retrovir (zidovudine/AZT), and Epivir (lamivudine/3TC), three
nucleoside reverse transcriptase inhibitors (NRTIs) already approved by FDA.
Eviplera combines Gilead's Truvada, a fixed-dose combination of the two
nucleoside reverse transcriptase inhibitors emtricitabine 200 mg and tenofovir disoproxil 245 mg, and Tibotec Pharmaceuticals' rilpivirine 25 mg, marketed by Janssen-Cilag International NV as Edurant.
In addition, ZDV and 3TC caused fewer adverse effects than combinations with different
nucleoside reverse transcriptase inhibitors, didanosine (ddI) and stavudine (d4T).