Changing Meds

[Pozbtm4breeding]

I tested poz in Oct 2008, started taking Atripla in Sept 2009 and was undetectable at my next exam at the end of 2009. Since then I have been on Atripla with very few, if any, side effects and remain undetectable. I take my meds consistently and have only missed 2-3 doses since I have been taking it. At my last appointment, my infectious disease doctor told me should we like for me to consider switching medications, she is suggesting either Stribild or a combo of Truvada & Ticivay. She said these medications are new improvements over Atripla and she starts newly diagnosed patients on Truvada & Ticivay. Also, she is not insisting that I do this only suggesting it. I completely trust my ID doctor, she has been amazing in too many ways to mention here. However, I am very hesitant about this as I have responded pretty well (I think) to Atripla. Has anyone switched meds and like to offer their opinion/advice?

[fillmyholeftl]

I also began Atripla in late 2008. Had the same experiences as you, very compliant, not side effects good HIGH CD4, undetectable.

I switched last year to COMPLERA. I (& my Dr) wanted to take the Sustiva (in Atripla) out. A lot of my peers are being switched to Stribild. When I made the changer, Complera was the "ONE".... I would only switch to a one pill a day regimen...

Good Luck

[bearbandit]

A lot of the reason for atripla falling out of favour with those who don't have problems with the side effects is that efavirenz (one of the three drugs in atripla) comes out of patent this year, thus allowing generic versions to be manufactured. This will have the knock-on effect of making atripla cheaper even though it's other two components (FTC and tenofovir, essentially truvada) are still in patent. In the UK we're expecting people on atripla to be switched to either a new combination pill containing generic efavirenz, or truvada plus generic efavirenz for economic reasons. In the US I can well imagine doctors being induced to steer people away from generic efavirenz, again for economic reasons. Money speaks louder than health

[rawTOP]

I've always heard that, when it comes to ARVs, if it's working don't fix it. I'm surprised she'd want to change your meds. If there were some problem, I could see the point, but if you're doing well, stay put.

[wood]

I tested poz in Oct 2008, started taking Atripla in Sept 2009 and was undetectable at my next exam at the end of 2009. Since then I have been on Atripla with very few, if any, side effects and remain undetectable. I take my meds consistently and have only missed 2-3 doses since I have been taking it. At my last appointment, my infectious disease doctor told me should we like for me to consider switching medications, she is suggesting either Stribild or a combo of Truvada & Ticivay. She said these medications are new improvements over Atripla and she starts newly diagnosed patients on Truvada & Ticivay. Also, she is not insisting that I do this only suggesting it. I completely trust my ID doctor, she has been amazing in too many ways to mention here. However, I am very hesitant about this as I have responded pretty well (I think) to Atripla. Has anyone switched meds and like to offer their opinion/advice?

All the popular (stibild, complera, atripla) one a day treatments have a truvada component to them (FTC/Tenofovir) So really you are not changing up your regime in terms of what you are taking all that much.

The main downside to Atripla is its Efavirenz component. Efavirenz, marketed on its own as Sustiva is a relatively old drug, with some fairly significant Psychiatric symptoms. With that said, its still highly effective, which is why its still used after many other drugs have been developed, or failed in testing. Complera has been shown to be just as effective and substitutes the Efavarienz component of Atripla with Rilpivirine, also known on its own as Edurant. This gives an overall lower side effect profile. It is of note that Complera has been shown to be less effective in first line treatment when viral loads are over 100k. Obviously this doesn't apply to you, but it is important to note for anyone starting treatment.

Stribild has also been shown to be just as effective and substitutes the Efavarienz compent of Atripla with elvitegravir/cobicistat. In this case Elvitegravir is the ingrese inhibitor and it is boosted by cobicistat.

What your doctor is trying to do is keep you on the same basic regamine, but eliminate the side effects of efavirenz. Its up to you if this is a problem for you. Some people are fine with efavirenz, and other people have horrible side effects. While it may seem like a big switch, you are really not changing 2/3 of your regemine, which is the Truvada or FTC/Tenofovir portion of your treatment. Doctors usually only want to switch to completely different drugs if they have stopped working or there is significant benefits to well being, side effects, etc.

If I was in your shoes I don't think i would switch at all. There will be more combination therapies coming that may be just as effective. Its also important to remember that you are only five years in, so depending on how old you are you may still be on treatment for a very long time. I think because of that I would go with the "if its not broke don't fix it" mentality. the other reason is that if you can tolerate the side effects efavirenz is EXTREMELY effective. Thats one of the reasons it is still used so often despite newer medications being available. With that said I am not a doctor, and your decision should be made by you, and your doctor.

Edited May 29, 2014 by wood

[Poz1956]

Your current drugs focus all their protection on one element of the HIV reproduction cycle -- reverse transcriptase. Your doctor's suggestion is to spread it out over two parts of the process - Reverse Transcriptase and Integrase. Conceptually I like that idea.

Then there is the additional point that Integrase inhibitors tend to achieve high concentrations in the genital track. That has the benefit of greater protection against onward transmission.

Ask your doctor. I'd be willing to bet those are exactly her reasons for suggesting the switch.

Remember that because you haven't developed resistance to Efavirenz (Sustiva), its not "off the list" for the future. You could always go back to it if needed.

[jtonic]

what are the chances that a doctor recommends a treatment that ultimately doesn't work as well or doesnt increase cd4 ?

im scared of medical errors.

i got diagnosed last month.

[Pozbtm4breeding]

Thanks for the comments guys, I really appreciate it.

[jtonic]

what are the chances that a doctor recommends a treatment that ultimately doesn't work as well or doesnt increase cd4 ?

im scared of medical errors.

i got diagnosed last month.