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One Pill, Once Daily = Triple Therapy for HIV
A single tablet contains efavirenz, tenofovir, and FTC, one of the most effective triple-drug regimens available for treatment-naive patients.
When AZT/3TC (Combivir) was released in 1997 as the first coformulated HIV medication, some providers doubted whether it would catch on. After all, the pill burden was reduced only from two pills twice daily to one pill twice daily, and the components of Combivir were, of course, the same as the drugs administered individually. Despite the skepticism, however, Combivir proved to be enormously popular among patients and providers alike, a phenomenon that has since been repeated with coformulated AZT/3TC/abacavir (Trizivir), lopinavir/ritonavir (Kaletra), tenofovir/FTC (Truvada), and abacavir/3TC (Epzicom). Patients not only love the reduced pill burden of these coformulations but also cite reduced pharmacy co-pays as another major plus. Oddly enough, even drug-specific toxicities of the individual components sometimes appear to diminish, despite the biologic equivalence of the coformulated medications.
This year, the coformulation movement reached its ultimate milestone with the approval of efavirenz/tenofovir/FTC (Atripla), the first one-pill, once-daily regimen for HIV treatment. Not only does the tablet contain one of the most effective triple-drug regimens available for treatment-naive patients (ACC Feb 1 2006) — endorsed by both the U.S. Department of Health and Human Services and the International AIDS Society–USA guidelines — but it also represents an unprecedented collaboration (at least in HIV treatment) between pharmaceutical companies.
Naturally, efavirenz/tenofovir/FTC is not for everyone. Women of childbearing potential who are sexually active and not using reliable birth control should not receive efavirenz, and patients with baseline renal disease are likely better treated with an alternative to tenofovir. Perhaps the most important contraindication is a history of any NNRTI resistance. Indeed, this limitation has generated an occasional bittersweet exchange in clinical practice when patients have requested the new "single-pill" treatment, even though they harbor multidrug-resistant virus.
— Paul E. Sax, MD
Published in AIDS Clinical Care December 29, 2006