Gilead is the leader in the field. Truvada, one of its first single-pill blockbusters, was launched in 2004 and combined two medications used in a common HIV regimen, Viread and Emtriva.
Two years ago, the company introduced an even simpler pill, Atripla, that combined those two drugs with Sustiva, made by Bristol-Myers Squibb Co. The collaboration is a rare example of two drug companies jointly selling their combined medications, and the strategy has paid off handsomely.
Atripla is now the most prescribed treatment for patients starting HIV therapy in the U.S., according to the company, and it is expected to bring in more than $1 billion in sales this year. A regimen of Truvada costs about $850 a month; Atripla costs about $1,300. The drugs typically are covered by insurance, and the uninsured can get free HIV medications through state programs, although waits have grown.
"These drugs are a milestone because of how easy they are to use," said Dr. Homayoon Khanlou, a Los Angeles HIV specialist who estimates that the majority of his patients now take one pill a day as their HIV regimen. "People take it after dinner and they are done with their treatment."
Few drug companies saw HIV as a large and viable market a few years ago. Public pressure to keep HIV drug prices low and a trend of foreign countries' ignoring HIV drug patents and making cheaper versions on their own seemed like surefire profit killers.
"A lot of companies were scared off because of all the political and assumed financial pressure" around HIV drugs, Gilead Chief Executive John Martin said.
Martin said Gilead believed differently. In the 1990s, the company sold several HIV treatments, including one to treat a common eye problem in AIDS patients, and it acquired smaller companies with promising HIV drugs.
It also elected a high-profile chairman to its board: Donald Rumsfeld, who remained in the role until he left to join the Bush administration in 2001.
As its business has grown, Gilead has taken the thunder away from former HIV heavyweight GlaxoSmithKline, whose HIV sales have flattened over the last year.
"We recognized there was a significant unmet medical need in helping add ease to people's lives," Martin said.
Recently, Gilead has expanded into other areas. It won approval last summer for a drug to treat pulmonary arterial hypertension, which affects about 100,000 in the U.S.
For the time being, however, HIV is likely to remain the company's bread and butter.
The HIV drug market is expected to nearly double from $6 billion last year to as much as $11 billion by 2015, according to market analysis firm Datamonitor.
Some doctors are worried that easier-to-take HIV drugs might be partially responsible for the recent uptick in infections as more people view the disease as a manageable chronic illness.
Khanlou said public health experts and drug companies should continue to warn people that AIDS remains a deadly disease and that the public should remain vigilant.
"We've made too much progress to start going back," he said.
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daniel.costello@latimes.com
