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HIV+HBV Atripla alternative
Dec 28, 2013

I have been co-infected for over 25 years. Always been somewhat resistant to the HIV even without meds. I am currently taking Atripla (5 years now) and am undetectable for both HBV and HIV. Very healthy CD4 over 1000. I could lose 10 or 15 pounds prior drugs (Trizivir) caused minimal lypodistrophy in my belly. The Atripla causes me very vivid and sometimes disturbing dreams. To the point where I am striking out with punches while asleep. Not fun for my partner. Also kills my sex drive after I take a dose. I just want to sleep. Is there any risk to switching to Complera or Stribild. I'm more worried about the HBV than the HIV. What would you see as the most advantageous path forward? I also take Prozac 40mg 1x day. Had depression with Trizivir before the Atripla. That's under control now. Want to keep it that way.

Response from Dr. Taylor

There are a number of issues here.

First, HIV and hep B are both very important. Maintaining a non-detectable HIV RNA (viral load) is important for your health and helps your immune system regarding HIV, as WELL as helping your liver health regarding hepatitis B. Ideally everyone with both viruses should maintain a non-detectable HIV RNA and non-detectable HBV DNA.

It does not sound as though you are resistant to Atriplacongratulations it is working very well!

When switching to complera or stribild, it is important to consider both the HIV and hepatitis B viruses. Atripla is a combination of efavirenz, emtricitabine, and tenofovir . Emtricitabine and tenofovir have activity against both HIV and hepatitis B. Tenofovir is the most potent hepatitis B medication. With HIV you need 3 antiviral medications.

Complera is a combination of rilpivirine, emtricitabine and tenofovir. Stribild is a combination of elvitegravir, cobicistat, tenofovir and emtricitabine. So the hepatitis B medications will be the same no matter which pill you take for your HIV. Talk with your doctor about your HIV genotype and any prior resistance. This will help shape which HIV medications will keep your HIV RNA fully suppressed.

Prozac can decrease your sexual drive and function, so this is another thing to discuss with your doctor.

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