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"If it ain't broke - don't try fixin it" - really?
Dec 23, 2009

I've been on Atripla for 6 months and it seems to be working fine. My VL went down from 30K to U/D. My absolute CD4 count has not changed as of yet (still around 280-300) but the % has gone up (from 18-20% to 30-35%), so it seems I'm on the right track. Most initial side effects have subsided after first month (dizzy/groggy mornings). I still have the vivid dreams, general fatigue and somewhat elevated trigs (still below limit, but higher than before). Before I started the Atripla treatment I have talked to my doc about the Isentress/Truvada combo. That was before it had been approved for paitient naive treatment, and he recommended against it due to lack of long data. Now that it has been approved and even labeled "preferred" - should I insist on switching? True the Atripla has the edge of once a day dosing vs. twice a day Isentress but (a) that might changed soon and (b) is offset by the burden of having to take Atripla on empty stomach all the time. Adherence is not an issue for me so if the Isentress combo works just as well if not better (better CD4 increase), less side effects (metabolic, mental, fatigue/memory, etc.) and no need to be bothered with food all the time - why not switch right now? A second question: if I did switch and for some reason the Isentress combo did not work well for me - can I switch right back to Atripla? Thanks for any thought/recommendation.

Response from Dr. Frascino

Hello,

Switching from one fully suppressive combination antiretroviral regimen to another equally effective regimen would not be a problem. It's possible the Isentress/Truvada regimen may be better tolerated than your current Atripla. Will the new regimen be more effective in promoting immune reconstitution (increase in CD4 count)? Unfortunately, no one knows. Consequently, the main reason to consider a switch at this point would be side effects/toxicities. As for switching back to Atripla, this would not be a problem, assuming you have not developed resistance to any of the three agents contained within Atripla in the interim. Finally, we still don't have long-term data on Isentress, but from the information collected to date, it appears to be highly effective and very well tolerated.

Good luck.

Dr. Bob


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