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On March 20, 2003, Health Canada granted approval for sale of the drug Viread (tenofovir). This drug is to be used as part of combination therapy for the treatment of people with HIV/AIDS.

Because health care is administered by Canada's provinces and territories, it will be months before tenofovir appears on their subsidized drug lists or formularies. One factor that may affect the speed at which tenofovir appears on formularies will be its cost. Currently, no Canadian price has been selected by the company. In the United States, one month's supply of tenofovir costs $433USD (approx. $640CDN as of July 2004; $488CDN as of November 2006).

The manufacturer of tenofovir, Gilead Sciences, hopes to re-activate its Canadian expanded access program in the coming months. However, the new program will make tenofovir available only to a limited number of people. To gain access to tenofovir, Canadian physicians must have patients with the following profile:

• viral load greater than 10,000 copies
• fewer than 100 CD4+ cells

Doctors will also have to supply evidence that their patients are resistant to many other available drugs, indicating that tenofovir is a last option. Therefore, results of genotypic or phenotypic drug resistance testing will be needed.

For further information, physicians may contact Gilead directly at 1.800.GILEAD-5 and follow the voice prompts.

Tenofovir can cause nausea, vomiting, diarrhea, and flatulence (intestinal gas). Individuals must be careful if they use Viread in combination with ddI because this combination can increase ddI levels in the blood by as much as 60%. This increase in ddI levels may, in turn, increase the risk of side effects that can be caused by ddI, such as life-threatening pancreatitis and peripheral neuropathy.

Because HIV can infect brain cells, it's important to consider a drug's ability to reach the brain when putting together an anti-HIV regimen. It's probably wise to include at least one drug that has been shown to cross the blood-brain barrier to some useful degree as part of your regimen. These include AZT (zidovudine, Retrovir), d4T (stavudine, Zerit), abacavir (Ziagen), nevirapine (Viramune), amprenavir (Agenerase) and to a lesser degree indinavir (Crixivan) and 3TC (lamivudine, Epivir). Efavirenz (Sustiva) has not been shown to cross the barrier to a significant degree, but some experts speculate that it might have some useful effect in impacting HIV in the spinal fluid.