Nucleoside reverse transcriptase inhibitors ("nukes") prevent HIV from reproducing itself at a different stage of the replication process than protease inhibitors. So it works very well to combine two “nukes” with a protease inhibitor to attack the virus at two different stages of viral replication. However, it is also possible to make an effective “cocktail” by combining nukes with a non-nucleoside reverse transcriptase inhibitor (“non-nuke”).

All “nukes” carry with them a rare but potentially dangerous side-effect: a build-up of lactic acid in the blood and an enlarged liver.

Recommended dose is one 300-mg tablet once a day or one 150 mg tablet twice a day. You can take it without regard to meals.

Evaluation: In official guidelines, Epivir is listed as having “minimal toxicity”—meaning it has almost no unpleasant side-effects. You don’t see that very often with an HIV medication! It can be taken either once a day or twice a day—your choice—so the dosing is easy and convenient. This is a very good HIV medication. Epivir is one of the ingredients of Combivir, Trizivir, and Epzicom. Epivir is listed as a “preferred” drug in the current DHHS guidlines.

Standard dose is one 200 mg once a day.

Evaluation: Emtriva was approved by the FDA in 2003. It is a very popular drug. It is frequently compared to Epivir — which is not a bad thing, since Epivir is an effective drug with very few side effects.

Emtriva's dosing is very convenient - just one pill, once-a-day. Like Epivir, Emtriva is listed as “preferred” in the current DHHS guidlines. It was moved into the "preferred" category very shortly after it was introduced - evidence of how effective and easy-to-tolerate it is. Emtriva is one of the ingredients of Truvada.

Emtriva is also effective against Hepatitis B - a nice bonus, since many people with HIV also have Hepatitis B.

Comes in 300 mg tablets. Standard dose is one tablet, once-a-day, with food.

Evaluation: Viread is a very popular drug. It represents a whole new class of drugs—it is a nucleotide reverse transcriptase inhibitor. In tests, it was highly effective in patients who were resistant to other drugs. Viread is listed as “preferred” in the current DHHS guidlines. Viread is one of the ingredients in Truvada.

Viread is technically is a class by itself: it is a Nucleotide Reverse Transcriptase Inhibitor. However, since it is so similar to drugs like Epivir, Emtriva and Retrovir, it is commonly lumped in with the Nucleoside Reverse Transcriptase Inhibitors, as we have done here.

Comes in 100 mg and 300 mg capsules, 10 mg/mL IV solution and 10 mg/mL oral solution. Recommended dose is 200 mg (two 100 mg. capsules) three times a day or 300 mg (one 300 mg capsule) twice a day. You can take it without regard to meals.

Evaluation: Retrovir was the first drug found to be effective against HIV—and it’s still one of the most effective. In the early days (when it was usually called AZT) it got a bad reputation because it was often given in excessively high doses and because it didn’t work for long by itself. (Nothing does!) Now, however, they’ve got the appropriate dosing figured out, and it is a mainstay of multiple-drug therapy. It is a key ingredient of both Combivir and Trizivir. Additionally, it is an effective treatment for preventing the transmission of HIV from mother to baby. More people owe their lives to Retrovir than any other HIV drug. Retrovir is listed as a “preferred” drug in the current DHHS guidelines.

Comes in 300 mg tablets and 20 mg/mL oral solution. Recommended dose is 300 mg (one tablet) twice a day. You can take it without regard to meals.

Evaluation: Ziagen is a popular drug. It’s easy to take—one pill twice a day. And even easier as one of the ingredients of Trizivir and Epzicom. Ziagen carries with it the risk of a hypersensitivity reaction, which may include fever, rash, fatigue, nausea, vomiting, diarrhea, and abdominal pain. You should quit using Ziagen as soon as a hypersensitivity reaction is suspected, and never try it again—it can be fatal. This hypersensitivity reaction occurs in about 5% - 8% of the people who use Ziagen.

Comes in 400 mg enteric coated capsules. Recommended dose is one capsule once a day.

This current version of Videx—Videx EC—uses a buffering agent to get around the stomach acid problem. The drug is “enteric coated” into little beadlets that pass right through the stomach, and then dissolve when they reach the small intestine, releasing their medicine there. This eliminates most of the problems with stomach upset and drug interactions. As an added bonus, it’s much easier to take: just one capsule, once a day.

Comes in 15, 20, 30 and 40 mg capsules and 1 mg/mL oral solution. Recommended dose for people weighing more than 132 pounds in 40 mg (one 40 mg capsule) twice a day. Recommended dose for people weighing less than 132 pounds is 30 mg (one 30mg capsule) twice a day. You can take it without regard to meals.

Evaluation: In the most recent revision of the DHHS guidlines, Zerit was downgraded from “preferred” to “alternative” due to “increasing reports of stavudine (Zerit)-associated toxicities.”

HIVID has never been a highly effective drug. Hardly anybody takes it. It is obsolete.

Copyright 2006, Positive Health Publications, Inc.

This information is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!