Gilead Announces 48-Week Data Evaluating Switching from Combivir(R) To Truvada(R) Among Virologically-Suppressed HIV Patients



    Gilead Sciences, Inc. (Nasdaq:GILD) today announced 48-week data
    from a Phase III clinical trial evaluating virologically-suppressed
    patients with HIV who switched from treatment with twice-daily
    Combivir(R) (lamivudine/zidovudine) to treatment with Gilead´s
    once-daily Truvada(R) (emtricitabine and tenofovir disoproxil
    fumarate) as part of their combination drug therapy. In the SWEET
    (Simplification With Easier Emtricitabine and Tenofovir) study,
    patients who switched from Combivir to Truvada, both in combination
    with once-daily Sustiva(R) (efavirenz), experienced improvements in a
    number of treatment-related side effects. Patients in both study arms
    maintained virological suppression at 48 weeks. The data were
    presented at the 11th European AIDS Conference (EACS), held October
    24-27 in Madrid, Spain.

    "As HIV patients live longer and remain on therapy for extended
    periods of time, the long-term side effect profile of treatment is
    increasingly more important," said Martin Fisher, MD, Brighton and
    Sussex University Hospitals, Brighton, United Kingdom and the
    principal investigator for the SWEET study. "Data from this study
    indicate that patients on long-term Combivir therapy without clinical
    lipoatrophy may benefit from switching to Truvada, as virological
    control can be maintained and limb fat loss and recovery may be
    improved. These data support the new EACS 2007 guidelines regarding
    proactive switching."

    New European HIV treatment guidelines issued this week at EACS
    list Truvada among the recommended components of a first-line
    treatment regimen for antiretroviral naive patients. Combivir,
    previously recommended as a first-line treatment option, is now listed
    as an alternative treatment option.

    In the United States, the components of Truvada and Sustiva are
    available in a fixed-dose combination tablet called Atripla(R)
    (efavirenz 600mg / emtricitabine 200mg / tenofovir disoproxil fumarate
    300 mg). Atripla is currently the first and only once-daily single
    tablet regimen approved for the treatment of HIV-1 infection in adults
    in the United States for use either as stand-alone therapy or in
    combination with other antiretroviral agents. On October 18, 2007, the
    Committee for Medicinal Products for Human Use (CHMP) of the European
    Medicines Agency (EMEA) recommended that Atripla be approved for use
    in the European Union. A final decision on Atripla by the European
    Commission is expected by the end of the year.

    About The SWEET Study

    SWEET was a 48-week, multicenter, prospective, open-label study
    evaluating 250 HIV-infected patients. At study entry, patients
    received a treatment regimen of Combivir and Sustiva and were
    virologically controlled with HIV RNA of less than 50 copies/mL for
    the last two consecutive testings and less than 400 copies/mL for more
    than three months. Of the 250 patients enrolled in the study, 234
    received at least one dose of study drug. Subjects were randomized 1:1
    to continue with a regimen of Combivir and Sustiva (n=117) or switch
    to a regimen of Truvada and Sustiva (n=117). Baseline characteristics
    were well matched between study arms. The median prior use of Combivir
    among patients was 36 months. Among patients who switched to Truvada
    and Sustiva, 88 percent were suppressed to less than 50 copies/mL at
    48 weeks, compared to 85 percent of patients who continued with
    Combivir (intent-to-treat, missing = failure analysis; 95% CI: -6% to
    +11%; p=0.70). In addition, median CD4 counts remained comparable
    between the study arms.

    Limb fat was measured using DEXA scans in a subset of 100 study
    participants, of whom 74 had both baseline and 48-week data available.
    In this sub-study, a median increase in limb fat of 0.21 kg was
    observed among patients who switched to Truvada and a median decrease
    of 0.14 kg was observed among patients who continued on Combivir
    (p=0.025). Differences in limb fat were more pronounced among patients
    who had less experience with AZT (zidovudine).

    At week 48, a median increase in hemoglobin of 0.5 g/dL was
    observed among Truvada patients and a median decrease of 0.1 g/dL was
    observed among those taking Combivir (p less than 0.001). Twenty-two
    percent of patients who switched to Truvada (n=22) experienced an
    increase in hemoglobin greater than 1 g/dL at 48 weeks compared to 2
    percent of Combivir patients (n=2). Conversely, 9 percent of patients
    who remained on Combivir (n=8) experienced a reduction in hemoglobin
    greater than 1 g/dL, compared to 2 percent of patients who switched to
    Truvada (n=2).

    Truvada patients in the study also experienced improvements across
    a number of lipid parameters. After 48 weeks of treatment, fasting
    total cholesterol fell by a median of 0.22 mmol/L (8.46 mg/dl) among
    Truvada patients, compared to a reduction of 0.06 mmol/L (2.30 mg/dl)
    among Combivir patients (p=0.23; Truvada vs. Combivir comparison).
    Fasting triglycerides fell by a median of 0.17 mmol/L (15.45 mg/dl)
    among Truvada patients, but increased by 0.04 mmol/L (3.63 mg/dl)
    among those who continued treatment with Combivir (p=0.11; Truvada vs.
    Combivir comparison).

    Renal function remained within normal ranges in both treatment
    arms after 48 weeks of treatment, as measured by creatinine clearance
    (Cockroft-Gault) and estimated glomerular filtration rate (MDRD).
    Median creatinine increased by 3 umol/L (less than 0.01 mg/dl) among
    Truvada patients (p less than 0.001), and declined by 1 umol/L (less
    than 0.01 mg/dl) among patients in the Combivir group (p=0.57).

    Five percent of Combivir patients and 3 percent of Truvada
    patients discontinued study drug due to adverse events. These included
    dizziness, insomnia, nausea, depression and sleep disorder in the
    Truvada arm and angiosarcoma, pulmonary embolism, pulmonary
    hypertension, weight loss of arms and legs, syncope, worsening of
    lipoatrophy and depression in the Combivir arm.

    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(R) (tenofovir disoproxil fumarate) or Emtriva(R)
    (emtricitabine), 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 of 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. The
    U.S. package insert advises that co-administration 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.

    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 cost in parts of the world where
    the epidemic has hit the hardest.

    For complete prescribing information for Truvada, visit
    www.truvada.com. For full prescribing information outside of the
    United States, physicians should consult their local product labeling.

    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 or Epivir-HBV (lamivudine), Epzicom
    (abacavir sulfate/lamivudine) or Trizivir (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%), suicidal ideation (0.7%), nonfatal suicide attempts
    (0.5%), aggressive behavior (0.4%), paranoid reactions (0.4%) and
    manic reactions (0.2%) 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%), insomnia
    (16.3%), impaired concentration (8.3%), somnolence (7.0%), abnormal
    dreams (6.2%) and hallucinations (1.2%) 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%) 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.

    Forward-Looking Statement

    This press release includes forward-looking statements, within the
    meaning of the Private Securities Litigation Reform Act of 1995, that
    are subject to risks, uncertainties and other factors, including the
    risk that as Truvada and Atripla are used over longer periods of time
    by many patients taking numerous other medicines, many of whom have
    underlying health problems, we may find new issues such as safety,
    resistance or drug interaction issues, which may require us to provide
    additional warnings or contraindications on our labels or narrow our
    approved indications, each of which could reduce the market acceptance
    of these products. These risks, uncertainties and other factors could
    cause actual results to differ materially from those referred to in
    the forward-looking statements. The reader is cautioned not to rely on
    these forward-looking statements. These and other risks are described
    in detail in Gilead´s Annual Report on Form 10-K for the year ended
    December 31, 2006 and its Quarterly Reports on Form 10-Q for the first
    and second quarters of 2007, as filed with the U.S. Securities and
    Exchange Commission. All forward-looking statements are based on
    information currently available to Gilead, and Gilead assumes no
    obligation to update any such forward-looking statements.

    U.S. full prescribing information for Truvada, Atripla, Viread and
    Emtriva are available at www.gilead.com.

    Truvada, Viread and Emtriva are registered trademarks of Gilead
    Sciences, Inc. Atripla is a registered trademark of Bristol-Myers
    Squibb & Gilead Sciences, LLC.

    For more information on Gilead, please call the Gilead Public
    Affairs Department at 1-800-GILEAD-5 (1-800-445-3235) or visit
    www.gilead.com.