144-Week Data from Gilead's Study 934 Comparing Truvada(R) to Combivir(R) Both in Combination with Sustiva(R) Presented At International AIDS Society Meeting in Sydney



    Gilead Sciences, Inc. (Nasdaq:GILD) today announced the
    presentation of 144-week data from an ongoing clinical trial, Study
    934, comparing a once-daily regimen of Truvada(R) (emtricitabine and
    tenofovir disoproxil fumarate) and Sustiva(R) (efavirenz) to a
    twice-daily regimen of Combivir(R) (lamivudine/zidovudine) with
    Sustiva once daily in treatment-naive adults with HIV. Data were
    presented by Jose Arribas, MD, of the University Hospital La Paz,
    Madrid, Spain at the 4th International AIDS Society Conference on HIV
    Pathogenesis, Treatment and Prevention taking place July 22-25 in
    Sydney, Australia (Poster #WEPEB029).

    Study 934 is an ongoing Phase III, open-label clinical trial in
    the United States and Europe. Truvada is a fixed-dose once-daily
    tablet containing Gilead's Viread(R) (tenofovir disoproxil fumarate)
    and Emtriva(R) (emtricitabine). At study initiation, patients received
    Viread and Emtriva with Sustiva. At week 96, which coincided with
    commercial availability of Truvada in the United States, all patients
    receiving Viread, Emtriva and Sustiva were switched to receive a
    simplified regimen of Truvada and Sustiva. Truvada is currently the
    most commonly prescribed nucleoside backbone for combination HIV
    therapy in the United States.

    Truvada and Sustiva are also available in the United States as the
    fixed-dose product Atripla(TM) (efavirenz 600 mg/ emtricitabine 200
    mg/ tenofovir disoproxil fumarate 300 mg), through a U.S. joint
    venture between Bristol-Myers Squibb Company and Gilead Sciences.
    Atripla was approved in the United States on July 12, 2006.

    "These data demonstrate the safety and efficacy profile of the
    components of Atripla over three years," commented Dr. Arribas. "As
    the treatment landscape for HIV improves and patients live longer, the
    importance of a proven and durable first-line regimen with simple
    dosing is critical."

    Study 934 Results

    Study 934 is a Phase III, open-label, non-inferiority study that
    enrolled 517 HIV-infected patients in the United States and Europe.
    Two patients were protocol violations and six never received drug,
    resulting in an intent to treat population of 509 patients. The
    study's primary endpoint was at 48 weeks and the study has continued
    through 144 weeks. Twenty-two patients with baseline non-nucleoside
    reverse transcriptase inhibitor (NNRTI) mutations and 31 patients who
    completed week 48 and week 96 of the study with HIV RNA (viral load)
    less than 400 copies/mL but did not consent to participate after week
    96 were excluded from the week 144 efficacy population. Participants
    were originally randomized to receive Viread 300 mg, Emtriva 200 mg
    and Sustiva 600 mg, all dosed once daily, or Combivir twice daily and
    Sustiva 600 mg once daily. At study entry, patients were
    treatment-naive, had HIV RNA greater than 10,000 copies/mL and any CD4
    cell count. At week 96, patients receiving Viread, Emtriva and Sustiva
    were switched to a regimen of Truvada/Sustiva.

    After 144 weeks of treatment, 71 percent of Truvada/Sustiva
    patients compared to 58 percent of Combivir/Sustiva patients achieved
    and maintained viral load less than 400 copies/mL using the Time to
    Loss of Virologic Response algorithm (TLOVR) (n=456, p=0.004; 95% CI,
    +4.2% to +21.6%). Sixty-four percent of patients in the
    Truvada/Sustiva arm compared to 56 percent of patients in the
    Combivir/Sustiva arm achieved and maintained viral load less than 50
    copies/mL using TLOVR (n=458, p=0.08; 95% CI, -0.8% to +17%). The mean
    increase from baseline in CD4 cell counts at week 144 was 312 and 271
    cells/mm(3) in the Truvada/Sustiva and Combivir/Sustiva arms,
    respectively (p=0.09).

    Genotypic resistance analyses were performed on patients without
    pre-existing baseline NNRTI resistance mutations who either had
    confirmed plasma HIV RNA greater than 400 copies/mL or discontinued
    study drug early. Through 144 weeks, no patients in either arm of the
    study developed the K65R mutation, which is associated with reduced
    susceptibility to Viread. Fewer Truvada/Sustiva patients developed the
    M184V/I mutation, which is associated with resistance to Emtriva and
    to the lamivudine component of Combivir (2 vs. 10 patients; p=0.02).

    After 144 weeks of treatment, a significantly greater percentage
    of patients in the Combivir/Sustiva group experienced adverse events
    that resulted in discontinuation of study medications compared to the
    Truvada/Sustiva arm (11 vs. 5 percent, respectively; p=0.01). The most
    common cause of discontinuation in the Combivir/Sustiva arm was
    anemia/hemoglobin decrease (14 vs. 0 patients in the Truvada/Sustiva
    arm), and in the Truvada/Sustiva arm was rash (4 patients vs. 1
    patient in the Combivir/Sustiva arm).

    Renal adverse events were uncommon at 144 weeks, consistent with
    study data at weeks 48 and 96. No patient discontinued study
    medication due to renal events.

    After 144 weeks of treatment, patients in the Combivir/Sustiva arm
    experienced greater mean elevations from baseline in fasting total
    cholesterol levels (36 vs. 24 mg/dL in the Truvada/Sustiva arm;
    p=0.005) and greater mean increases from baseline in fasting
    triglycerides (36 vs. 4 mg/dL in the Truvada/Sustiva arm; p=0.047).

    Loss of limb fat, a marker for lipodystrophy, was observed among
    patients receiving Combivir/Sustiva. Among 269 patients with available
    data, median total limb fat was significantly less in patients
    receiving Combivir/Sustiva compared to patients receiving
    Truvada/Sustiva (5.4 vs 7.9 kg; p less than 0.001) at week 144. Among
    patients with data available at 48 and 144 weeks, median total limb
    fat decreased significantly in the Combivir/Sustiva arm (from 6.0 kg
    to 4.9 kg; n=49, 38) and increased significantly in the
    Truvada/Sustiva arm (from 7.4 kg to 8.3 kg; n=51, 48).

    Data from this analysis have not been reviewed by the U.S. Food
    and Drug Administration.

    Important Product Safety Information About Truvada and Atripla

    Lactic acidosis and severe hepatomegaly with steatosis, including
    fatal cases, have been reported with the use of nucleoside analogues
    alone or in combination with other antiretrovirals. Truvada and
    Atripla are not approved for the treatment of chronic hepatitis B
    virus (HBV) infection and their safety and efficacy have not been
    established in patients co-infected with HBV and HIV. Severe acute
    exacerbations of hepatitis B have been reported in patients who have
    discontinued Viread or Emtriva, which are components of Truvada and
    Atripla. In some of these patients treated with Emtriva, the
    exacerbations of hepatitis B were associated with liver decompensation
    and liver failure. Hepatic function should be monitored closely with
    both clinical and laboratory follow-up for at least several months in
    patients who are co-infected with HIV and HBV and discontinue Truvada
    or Atripla. If appropriate, initiation of anti-hepatitis B treatment
    may be warranted.

    It is important for patients to be aware that anti-HIV medicines
    including Truvada and Atripla do not cure HIV infection or AIDS and do
    not reduce the risk of transmitting HIV to others.

    Additional Important Information About Truvada

    Truvada is a fixed-dose combination tablet containing 200 mg of
    emtricitabine (Emtriva) and 300 mg of tenofovir disoproxil fumarate
    (Viread). In the United States, Truvada is indicated in combination
    with other antiretroviral agents, such as non-nucleoside reverse
    transcriptase inhibitors or protease inhibitors, for the treatment of
    HIV-1 infection in adults.

    It is not recommended that Truvada be used as a component of a
    triple nucleoside regimen. Truvada should not be coadministered with
    Atripla, Emtriva, Viread or lamivudine-containing products, including
    Combivir (lamivudine/zidovudine), Epivir(R) or Epivir-HBV(R)
    (lamivudine), Epzicom(TM) (abacavir sulfate/lamivudine) or Trizivir(R)
    (abacavir sulfate/lamivudine/zidovudine). In treatment-experienced
    patients, the use of Truvada should be guided by laboratory testing
    and treatment history.

    Emtricitabine and tenofovir are principally eliminated by the
    kidneys. Renal impairment, including cases of acute renal failure and
    Fanconi syndrome (renal tubular injury with severe hypophosphatemia),
    has been reported in association with the use of Viread, a component
    of Truvada. It is recommended that creatinine clearance be calculated
    in all patients prior to initiating therapy with Truvada and as
    clinically appropriate during therapy. Routine monitoring of
    calculated creatinine clearance and serum phosphorous should be
    performed in patients at risk for renal impairment. Dosing interval
    adjustment and close monitoring of renal function are recommended in
    all patients with creatinine clearance 30-49 ml/min. Truvada should be
    avoided with concurrent or recent use of a nephrotoxic agent.

    No drug interaction studies have been conducted using Truvada.
    Coadministration of Truvada and didanosine should be undertaken with
    caution. Patients should be monitored closely for
    didanosine-associated adverse events and didanosine should be
    discontinued if these occur. Patients on atazanavir and
    lopinavir/ritonavir plus Truvada should be monitored for
    Truvada-associated adverse events and Truvada should be discontinued
    if these occur. When co-administered with Truvada, it is recommended
    that atazanavir be given with ritonavir 100 mg. Atazanavir without
    ritonavir should not be co-administered with Truvada.

    Decreases in bone mineral density (BMD) at the lumbar spine and
    hip have been seen with the use of Viread. The effect on long-term
    bone health and future fracture risk is unknown. Cases of osteomalacia
    (associated with proximal renal tubulopathy) have been reported in
    association with the use of Viread.

    Changes in body fat have been observed in patients taking anti-HIV
    medicines. The mechanism and long-term health effect of these
    conditions are unknown. Immune Reconstitution Syndrome has been
    reported in patients treated with combination therapy, including
    Viread and Emtriva.

    Adverse events observed with Viread and Emtriva used in
    combination in Study 934 were generally consistent with those seen in
    other studies in treatment-experienced or treatment-naive patients
    receiving Viread and/or Emtriva. Treatment-emergent adverse events
    occurring in at least 3 percent of patients receiving Viread and
    Emtriva in Study 934 included dizziness (8%), diarrhea (7%), nausea
    (8%), fatigue (7%), sinusitis (4%), upper respiratory tract infections
    (3%), nasopharyngitis (3%), somnolence (3%), headache (5%), dizziness
    (8%), depression (4%), insomnia (4%), abnormal dreams (4%) and rash
    (5%).

    Skin discoloration has been reported with higher frequency among
    Emtriva-treated patients. Skin discoloration, manifested by
    hyperpigmentation on the palms and/or soles was generally mild and
    asymptomatic. The mechanism and clinical significance are unknown.

    The parent compound of Viread was discovered through a
    collaborative research effort between Dr. Antonin Holy, Institute for
    Organic Chemistry and Biochemistry, Academy of Sciences of the Czech
    Republic (IOCB) in Prague and Dr. Erik DeClercq, Rega Institute for
    Medical Research, Katholic University in Leuven, Belgium. The
    inventors of Viread have agreed to waive their right to a royalty on
    sales of Viread and Truvada in the Gilead Access Program countries to
    ensure the product can be offered at a no-profit price in parts of the
    world where the epidemic has hit the hardest.

    For complete prescribing information for Truvada, visit
    www.truvada.com.

    Additional Important Information About Atripla

    In the United States, Atripla is indicated for use alone as a
    complete regimen or in combination with other antiretroviral agents
    for the treatment of HIV-1 infection in adults.

    Atripla contains the components Truvada (emtricitabine and
    tenofovir disoproxil fumarate) and Sustiva (efavirenz), co-formulated
    as a single tablet. As such, the important safety information
    appearing in the above Truvada section also applies to Atripla, in
    addition to the following important product information.

    As a fixed-dose regimen of Viread (tenofovir disoproxil fumarate),
    Emtriva (emtricitabine) and Sustiva (efavirenz), Atripla should not be
    coadministered with Viread, Emtriva, Truvada (emtricitabine and
    tenofovir disoproxil fumarate) or Sustiva. Due to similarities between
    Emtriva and lamivudine, Atripla should not be coadministered with
    drugs containing lamivudine, including Combivir
    (lamivudine/zidovudine), Epivir(R) or Epivir-HBV(R) (lamivudine),
    Epzicom(TM) (abacavir sulfate/lamivudine) or Trizivir(R) (abacavir
    sulfate/lamivudine/zidovudine).

    Atripla should not be taken with Hismanal(R) (astemizole),
    Vascor(R) (bepridil), Propulsid(R) (cisapride), Versed(R) (midazolam),
    Orap(R) (pimozide), Halcion(R) (triazolam), ergot medicines (for
    example, Wigraine(R) and Cafergot(R)), or Vfend(R) (voriconazole) due
    to a contraindication with efavirenz. Use of Atripla with St. John's
    wort (Hypericum perforatum) or St. John's wort-containing products is
    not recommended. This list of medicines is not complete. Patients
    should discuss all prescription and non-prescription medicines,
    vitamin and herbal supplements, or other health preparations they are
    taking or plan to take with their healthcare provider.

    Atripla should not be given to patients with creatinine clearance
    less than 50 ml/min.

    Serious psychiatric adverse experiences, including severe
    depression (2.4 percent), suicidal ideation (0.7 percent), nonfatal
    suicide attempts (0.5 percent), aggressive behavior (0.4 percent),
    paranoid reactions (0.4 percent) and manic reactions (0.2 percent)
    have been reported in patients treated with efavirenz, a component of
    Atripla. In addition to efavirenz, factors identified in a clinical
    study that were associated with an increase in psychiatric symptoms
    included a history of injection drug use, psychiatric history and use
    of psychiatric medication. There have been occasional reports of death
    by suicide, delusions, and psychosis-like behavior, but it could not
    be determined if efavirenz was the cause. Patients with serious
    psychiatric adverse experiences should be evaluated immediately to
    determine whether the risks of continued therapy outweigh the
    benefits. Patients should tell their doctor if they have a history of
    mental illness or are using drugs or alcohol.

    Fifty-three percent of patients in clinical studies have reported
    central nervous system symptoms including dizziness (28.1 percent),
    insomnia (16.3 percent), impaired concentration (8.3 percent),
    somnolence (7.0 percent), abnormal dreams (6.2 percent) and
    hallucinations (1.2 percent) when taking efavirenz compared to 25
    percent of patients receiving control regimens. These symptoms usually
    begin during the first or second day of therapy and generally resolve
    after the first two to four weeks of therapy. After four weeks of
    therapy, the prevalence of central nervous system symptoms of at least
    moderate severity ranged from 5 to 9 percent in patients treated with
    regimens containing efavirenz. Nervous system symptoms are not
    predictive of the less frequent psychiatric symptoms.

    Women should not become pregnant or breastfeed while taking
    Atripla. Serious birth defects have been seen in children of women
    treated with efavirenz during pregnancy. Women must use a reliable
    form of barrier contraception, such as a condom, even if they also use
    other methods of birth control.

    Rash is a common side effect that usually goes away without any
    change in treatment. Rash may be a serious problem in some children.

    Patients with liver disease may require the healthcare provider to
    check liver function or check drug levels in the blood.

    Atripla should be used with caution in patients with a history of
    seizures. Convulsions have been observed in patients receiving
    efavirenz, generally in the presence of a known medical history of
    seizures.

    Invirase(R) (saquinavir) should not be used as the only protease
    inhibitor in combination with Atripla.

    The most significant adverse events observed in patients treated
    with Sustiva are nervous system symptoms, psychiatric symptoms and
    rash. The most common adverse events (at least 5 percent) observed in
    clinical studies with Sustiva include fatigue, pain, dizziness,
    headache, insomnia, impaired concentration, nausea, vomiting,
    diarrhea, depression, rash, and pruritus.

    For complete prescribing information for Atripla, visit
    www.atripla.com.

    About Gilead Sciences

    Gilead Sciences is a biopharmaceutical company that discovers,
    develops and commercializes innovative therapeutics in areas of unmet
    medical need. The company's mission is to advance the care of patients
    suffering from life-threatening diseases worldwide. Headquartered in
    Foster City, California, Gilead has operations in North America,
    Europe and Australia. Visit Gilead on the World Wide Web at
    www.gilead.com.

    Full U.S. prescribing information for Atripla is available at
    www.atripla.com.

    Full U.S. prescribing information for Truvada, Viread and Emtriva
    is available at www.gilead.com.

    Full U.S. prescribing information for Sustiva is available at
    www.bms.com.

    Atripla is a trademark of Bristol-Myers Squibb & Gilead Sciences,
    LLC.

    Truvada, Viread and Emtriva are registered trademarks of Gilead
    Sciences, Inc.

    Sustiva is a registered trademark of Bristol-Myers Squibb Pharma
    Company.