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Initiating HIV/AIDS Therapy in Treatment-Naïve Patients
Is there still a role for twice-daily dosing?
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Dr. Kwakwa (OC): We have a role for BID dosing. Once a day dosing also has a place, but I don't think that BID dosing will ever not have a place. Some of the compounds that are very useful in this disease process are better when used twice a day.
Dr. Wohlfeiler (OC): I don't think that you don't discard really good medications because they're b.i.d. I think it is a little bit of a tougher sell though now with patients. I think patients have heard so much about once a day medications that they come in often wanting at the outset. I try to accommodate them. But if I really think that it's not the best regimen, I'll discuss it with them and talk to them about this twice a day regimen. And I find that almost never has that been a problem that patients actually will accept twice a day regimens very well, will usually be very adherent to them. Anything obviously beyond twice a day doesn't work.
Dr. Bellos (OC): Again, that is a very patient-dependent issue. There are patients for which the optimal choice would be, for example, a twice-daily dosing. I recently saw a patient this week that was newly diagnosed and had Kaposi's sarcoma. There is old data looking at AZT, initiating antiretroviral therapy, and using-just initiating antiretroviral therapy, and improving Kaposi's. Most of that data was done with AZT, and so, for that reason, Combivir, or AZT/3TC, was a drug that I chose to use in that patient, simply because that's something that I have a comfort level with, and have a fair amount of experience with, so I think there are specific entities or times where one can use BID dosing, and still be effective in terms of the management of the patients. If you're going to start, for example, a protease inhibitor such as lopinavir/ritonavir using twice a day dosing, so that that drug has to be dosed twice a day, that's again something that is relevant. Additionally, if you're treating people who are considering pregnancy-for example, the twice daily dosing of Combivir and nelfinavir is actually recommended in those patients, because there has been no reported teratogenicity with that particular combination.
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