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A Single Pill for AIDS Nears Reality

The combination of tenofovir, FTC, and efavirenz might soon be available in a single pill.

For years, effective antiretroviral treatment has required HIV-positive patients to take a large handful of pills and capsules every day to stay healthy. Those days are now drawing to a close. In an industry-supported open-label trial, researchers randomized 517 treatment-naive HIV-positive patients to receive either a standard combination antiretroviral regimen (AZT, 3TC, and efavirenz) or a newer regimen (tenofovir, FTC, and efavirenz). Both regimens involved taking three pills daily.

At 48 weeks of treatment, 73% of the AZT group and 84% of the tenofovir group had undetectable viral loads (<400 copies/mL), and mean CD4 counts had increased by 158 and 190 cells/mm³, respectively. Both of these differences were significant. Treatment-limiting side effects, most often anemia, were significantly more common in the AZT group than in the tenofovir group.

Comment: As with most AIDS treatment trials, this study was designed to evaluate a regimen's efficacy and toxicity only over the short term, and the findings apply only to a subset of patients (in this case, those who are treatment-naive and able to tolerate the sometimes-incapacitating side effects of efavirenz). With these caveats, though, the findings do herald a new era in HIV treatment. A combination tenofovir/FTC pill now enables patients to take the tenofovir regimen evaluated here in only two pills daily. Furthermore, the manufacturers of that pill and the manufacturer of efavirenz have announced their intention to jointly sponsor the development and marketing of a single new pill that will combine all three drugs, the first-ever once-daily treatment for HIV.

— Abigail Zuger, MD

Published in Journal Watch HIV/AIDS Clinical Care February 1, 2006

Citation(s):

Gallant JE et al. Tenofovir DF, emtricitabine, and efavirenz vs. zidovudine, lamivudine, and efavirenz for HIV. N Engl J Med 2006 Jan 19; 354:251-60.

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