Which Are The Easiest Drug Combinations? (A Look At Fewer Pills and Once-A-Day Dosing) en español
What is simplification?
When we talk about simplifying HIV treatment, two factors usually come to mind: 1) reducing the total number of times that medication needs to be taken each day (the number of doses), and 2) reducing the total number of pills that need to be swallowed each time medication needs to be taken.
We have actually come a long way with respect to both of these simplification strategies. For example, when Retrovir (AZT) was first approved, back in March of 1987, it needed to be taken six times a day – one of the most frustrating dosing schedules in the history of anti-HIV drug treatment. More recently, the use of anti-HIV drug combinations can require HIV-positive people to swallow as many as 20 pills a day. But times are changing. Most drug combinations being used today only need to be taken twice a day, with several drugs both available and on the horizon that only need to be taken once a day. What's more, the number of pills HIV-positive people need to take is getting lower – some HIV-positive people are taking three-drug therapy using as few as two pills a day.
Is the "easiest" regimen, whether it's the fewest number of doses or the lowest number of pills, the best one to choose? Not necessarily, say many experts. Simplified drug regimens are an important factor to consider – whether you're starting treatment for the first time or thinking about a switch to an easier drug combination – but they are not the only one:
New to anti-HIV therapy: HIV-positive people who are starting therapy for the first time have the largest number of options available to them. Chances are their virus is sensitive to all of the drugs available, which means they have the pick of the litter. However, it is important to remember that some drug combinations are better than others for people starting treatment for the first time. While a drug combination should be easy to take, it should also be maximally effective against the virus and have as few side effects as possible. To learn more about drug combinations that are recommended by the U.S. Department of Health and Human Services – the arm of the federal government that oversees healthcare policies in the U.S. – check out our lesson,
Wanting to switch from a complex regimen to an easier one: There are numerous people who begin treatment with a drug combination, see their viral load go undetectable and their T-cell counts increase, only to become tempted by another drug regimen that seems easier to take than their current one. For example, some people who began treatment using the protease inhibitor Crixivan three times a day may be tempted to add the protease inhibitor Norvir to their regimen, which allows people to do away with the pesky midday dose and food restrictions of Crixivan (see "Simplifying Protease Inhibitors" later in this lesson to learn more about this option). In other situations, there is the possibility of dropping a more complicated drug – or an entire regimen – in exchange for a simpler one. Even if your viral load is undetectable at the time of switching, it is important that the medication(s) you switch to have a good track record of keeping viral load undetectable. Not all anti-HIV drugs or combinations of drugs are equal in this respect – it will be necessary for you and your doctor to consider both your history of anti-HIV medicines, your viral load and T-cell count before starting treatment (it's possible that a high pretreatment viral load may be harder to keep undetectable using simplified drug regimens), and the reputation of the drug(s) you want to switch to before deciding to "fix" a drug regimen that isn't necessarily broken.
Failed other drugs in the past: Even if you've tried and failed other anti-HIV drugs in the past, this does not mean that treatment needs to be unnecessarily complicated. Here's where drug-resistance testing can come in handy. Very often, it is only one or two drugs that stop working in a combination of three or four drugs. Knowing which drugs have stopped working – and which ones are still effective against the virus – can help you preserve easier-to-use drugs for future use. Because so many approved and experimental drugs are being reformulated to allow for fewer pills to be taken fewer times a day, the number of simplified options is increasing for all HIV-positive people, including those who have fewer new drugs to choose from. Working closely with your doctor, you should be able to come up with new treatment combinations that can control your viral load and keep your T-cells high using the fewest number of pills and daily doses possible.
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