| Chapter 1: | Introduction |
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ways to combine two or more types of antiretroviral drugs in a single pill. This means that those in therapy can now take only one pill per dose and in some cases once a day instead of taking three or more pills in a single dose, as was the case in the earlier days of HIV treatment. For example, Atripla—manufactured by Bristol-Myers Squibb and Gilead Sciences—is one example of a multiclass combination caplet approved by the FDA in 2006;it combines three different drugs, namely efavirenz, emtricitabine, and tenofovir disoproxil fumarate (U.S. Department of State [USDS], 2011). Kaletra, approved by the FDA in 2000 and manufactured by Abbott Laboratories, is a combination of two different drugs—lopinavir and norvir—in one capsule. Combivir is a combination of lamivudine and zidovudine. Trizivir is a combination of abacavir, lamivudine, and zidovudine (Cichocki, 2009).
Another way that pharmaceutical companies have tried to minimize the problem of nonadherence and side effects is through the invention of enteric-coated drugs, such as Videx, developed by Bristol-Myers Squibb and approved by the FDA in 2000. Videx is not new, though; it was the second anti-HIV drug approved by the FDA in 1991. Discontinued since the invention of the new Videx enteric-coated pill, this compound was initially manufactured in a chewable tablet that dissolves in the stomach. One advantage of enteric-coated drugs is that they release the medication not in the stomach but after the capsule has reached the small intestines, which may decrease the risk of certain side effects, such as nausea (Cichocki, 2009). Another advantage to the new enteric-coated Videx is that it can also be taken only once a day, minimizing the pill burden problem (Cichocki, 2009). Although some of the newly innovated medications such as enteric-coated pills are not yet available to those receiving free HAART in low-income countries (as in Uganda), such efforts by pharmaceutical companies are making anti-HIV medications easier and safer to take than before, all of which may improve medication regimen adherence, which in turn may reduce the risk of the development of drug-resistant HIV. Minimizing this risk in low-income nations such as Uganda is crucial given the large numbers of those infected with the disease. Drug-resistant HIV is transmissible. If large numbers of people