Viread

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AIDS virusViread belongs to a class of anti-HIV drugs called Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs). For a description of the life-cycle of the AIDS virus, and the targets of each class of drugs, click here.

Viread is being developed by Gilead Sciences. They have a web site that includes the full prescribing information:


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Viread (tenofovir)

Pronunciation(s): VEER-ee-ad; ten-OH-foh-veer



What is Viread?
  • Viread is an HIV medication. It is in a category of HIV medicines called nucleotide reverse transcriptase inhibitors. Viread prevents HIV from altering the genetic material of healthy CD4 cells. This prevents the cells from producing new virus and decreases the amount of virus in the body.
     
  • Nucleotide analogues, such as Viread, are very similar to nucleoside analogues [e.g., Retrovir (AZT), Ziagen (abacavir) and Emtriva (emtricitabine)]. The only difference is that nucleotide analogues, unlike nucleoside analogues, are chemically preactivated and thus require less processing in the body for them to become active.
     
  • Viread, manufactured by Gilead Sciences, was approved by the U.S. Food and Drug Administration for the treatment of HIV in 2001.
     
  • Viread is available in pharmacies as a single drug, which is always combined with other HIV drugs, or in the fixed-dose combination tablets Truvada (Viread and Emtriva), Atripla (Viread, Emtriva, and Sustiva [efavirenz]), and Stribild (Viread, Emtriva, elvitegravir and cobicistat).
     
  • Viread is also active against the hepatitis B virus (HBV), the virus responsible for hepatitis B. Although it has not been approved by the FDA for the treatment of hepatitis B, some doctors prescribe it to treat both hepatitis B and HIV. See What is known about side effects? below for more important information regarding Viread and hepatitis B.
     
  • Gilead has established a patient assistance program (PAP) for people living with HIV who do not have private or public health insurance and are unable to afford Viread. To learn more about the PAP for Viread, call Gilead (800-226-2056). For those with private health insurance, Gilead has established a program to help cover up to $200 toward each monthly Viread co-payment. To learn more about this co-pay program, call 866-784-3431.

What is already known about Viread?
  • The usual dose is one 300mg pill, taken once a day. If you have kidney problems, your health care provider may recommend that you take Viread less frequently.
     
  • Viread can be taken either with or without food.
     
  • Viread is approved for children 2 years of age and older. The dose will depend on the child's body weight. For children between 2 and 5 years of age, a powdered formulation of the drug is available. For older children who require a Viread dose lower than the once-daily 300 mg tablet used for adults, 150 mg, 200 mg and 250 mg tablets are now available. To learn about treatment options for children, click here.
     
  • Studies have demonstrated that Viread is effective for the treatment of HIV when combined with other HIV drugs, usually with at least one other nucleoside reverse transcriptase inhibitor (NRTI) and either a protease inhibitor or non-nucleoside reverse transcriptase inhibitor (NNRTI). Viread should not be taken alone (as monotherapy) or with just one other HIV drug.
     
  • For HIV-positive adults beginning anti-HIV drug therapy for the first time, Viread is listed as a "preferred" NRTI option—used in combination with Sustiva—by the United States Department of Health and Human Services in its treatment guidelines. To learn more about these recommendations and options, click here.
     
  • Viread is active against many strains of HIV resistant to Retrovir (AZT), Zerit (d4T), Videx/Videx EC (ddI), Hivid (ddC), and Ziagen (abacavir). There is also some data from studies indicating that HIV that has become resistant to Epivir (3TC) may be even more sensitive to Viread. The drug is also active against virus containing the Q151M mutation—a single mutation that results in high-level resistance to multiple nucleoside analogues.
     
  • Viread may be less active against strains of HIV that contain the K65R mutation in its reverse transcriptase gene. To figure out if your virus has this mutation, your doctor can order a genotypic drug-resistance test.

What about drug interactions?
  • Viread should not be taken at the same time as Stribild, Atripla, Truvada, or Hepsera. This is because these medications contain the same or similar active ingredients as Viread.
     
  •  HIV-positive people must be very careful about using Viread in combination with Videx/Videx EC (ddI). There are two important warnings to know about:
     
    • Drug regimens consisting of Sustiva (efavirenz) or Viramune (nevirapine) plus Viread and Videx EC have been associated with premature drug failure. If you are receiving Viread and Videx EC with either Sustiva or Viramune, you may want to discuss alternative options with your doctor.
       
    • Viread increases the amount of Videx EC in the body. This can increase the risk of Videx-related side effects. In turn, if Viread and Videx EC are used together, you may need to be followed more carefully and your health care provider may need to decrease your dose of Videx EC. If used with Viread, Videx EC should be taken at a dose of 250mg once a day (reduced from the usual daily dose of 400mg a day).
    •  Because there are now a number of concerns regarding the use of Viread in combination with Videx EC, many experts recommend avoiding this combination.
       
  • The protease inhibitors Reyataz (atazanavir), Prezista and Kaletra (lopinavir/ritonavir) can increase the amount of Viread in the blood, which could result in more side effects. You may need to be followed more carefully if you are taking Viread and Reyataz, Prezista or Kaletra together. Viread may decrease the amount of Reyataz in your blood. If you are taking Viread and Reyataz together you should also be taking Norvir.

What is known about side effects?
  • Lactic acidosis, which can be fatal, and severe liver problems have been reported in people taking nucleoside reverse transcriptase inhibitors (NRTIs). This may be more likely to occur in pregnant women. Contact your doctor immediately if you experience nausea, vomiting, or unusual or unexpected stomach discomfort; weakness and tiredness; shortness of breath; weakness in the arms and legs; yellowing of the skin or eyes; or pain in the upper stomach area.
     
  • Viread may cause bone problems. In one clinical trial conducted by the manufacturer involving HIV-positive patients who were new to HIV therapy, Viread [combined with Sustiva and Epivir] caused decreases bone in mineral density (osteopenia) at the hip and spine. Researchers are currently looking into the seriousness of this possible side effect. If you have a history of bone fracture or are at risk for osteopenia, your doctor may want to consider ordering bone scans on a regular basis while you are taking Viread. While it's not clear if calcium and vitamin D supplementation can help with this side effect, it might be beneficial if you are taking Viread.
     
  • Some patients treated with Viread have had kidney problems. It is recommended that your doctor order a simple laboratory test to calculate your "creatinine clearance," which is a measure of your kidney function, before you start taking Viread. Depending on the results of this test, you may not be able to take Viread, or you may need to take it less frequently. Viread can be problematic for HIV-positive people who have a history of kidney problems (renal impairment). If you have a history of kidney problems, your doctor should monitor your kidney function closely through regular blood tests. It is always important to be careful if using Viread in combination with drugs that cause kidney problems or other drugs that are removed from the body by the kidneys.
     
  • HIV drug regimens containing NRTIs, including Viread, can cause increased fat levels (cholesterol and triglycerides) in the blood, and abnormal body-shape changes (lipodystrophy; including increased fat around the abdomen, breasts, and back of the neck, as well as decreased fat in the face, arms, and legs). These side effects of HIV drug therapy are reviewed in our lessons on Lipodystrophy, Facial Lipoatrophy, and Risks To Your Heart (Hyperlipidemia).
     
  • In people living with HIV, the most common side effects of Viread are rash, headache, pain, diarrhea, depression, weakness, and nausea. Less common side effects include vomiting, dizziness and flatulence.
     
  • If you have hepatitis B and HIV and plan to stop taking Viread, you need close medical follow-up and for several months your doctor might want to frequently check your liver enzymes after stopping treatment. This is because Viread is also active against the hepatitis B virus (HBV). If Viread is stopped abruptly, it can cause liver disease to "flare" and damage the liver.

Can pregnant women take Viread?
  • Viread is classified by the FDA as a pregnancy category B drug. Pregnancy category B means that animal studies have failed to demonstrate a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women. Drug levels might be lower during the third trimester of pregnancy. A phase I clinical trial in late pregnancy is being conducted. HIV-positive women who become pregnant should discuss the benefits and possible side effects of HIV treatment to help protect their babies from HIV (see our lesson called Family Planning, Pregnancy & HIV).
     
  • It is not known whether Viread passes into breast milk and what effect they may have on a nursing baby. To prevent transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breast-feed.

What should I tell my doctor before taking Viread?
  • Before taking this medication, tell your doctor if you have: kidney disease; liver disease (including hepatitis B); or bone problems.
     
  • Tell your doctors and pharmacists about all medicines you take. This includes prescription medications, over-the-counter products, or herbal/natural remedies.

Last Revised: January 30, 2013

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