Mar 21, 2007
i am taking Atripla but hate the CNS effects. why can't i switch to Reyataz and Truvada and just take more of the Reyataz instead of adding Norvir? i really don't want to take Norvir, no AZT and NO D drugs. i don't want pi's. i know they say that fat loss is not common in Atripla but i know in the 9 months i've been on it i have lost fat in my arms, chest and shoulders so switching to a pi won't help. i am >50/794 cd4 so Viramune might not be a good choice either. Can i just take an extra 150mg of Reyataz? heck i dont even want the Reyataz. can i just take Truvada?
Response from Dr. Young
Thanks for your post.
It's unfortunate that you've got side effects from your current tenfovir, FTC and efavirenz regimen (Atripla). You are correct in pointing out that while uncommon fat loss (lipoatrophy) can occur among persons taking this regimen and that with your high CD4 count, nevirapine would not be a good alternative.
However, I'd correct you in some of the oversimplifications in protease inhibitors and lipo risk.
Indeed, just to show you how community perceptions may turn out to be wrong (in this case about the risk of lipoatrophy and protease inhbitors), an analysis by the US AIDS Clinical Trials Group (ACTG) showed that contrary to expectation, patients who took efavirenz appeared to have greater (not lesser) risk of developing fat loss compared to patients who took the boosted protease inhibitor lopinavir (aka, Kaletra).
As for the ritonavir issue, this boils down to once of drug levels, side effects and available clinical studies. Simply stated, the best conclusion that we can draw from these studies is to use atazanavir (Reyataz) with ritonavir when tenofovir-containing regimens are used. The extra dose of 'taz is generally associated with increased risk of developing side effects, so this was discarded as a strategy long ago. I'd definitely not recommend just taking tenofovir/FTC (Truvada), unless you're one that plays Russian roulette.
An alternative to using ritonavir/atazanavir with Truvada worth considering could be using abacavir-based combo with 'taz. We use the combo pill abacavir/3TC --Epzicom, Kivex) when we desire to use unboosted atazanavir. Since there isn't the drug interaction between abacavir and atazanvir (that tenfovir has), ritonavir isn't needed. This combo result in a 3 pill, once-daily regimen that is usually very well tolerated. While not (yet) FDA certified, recent studies have suggested that genetic prescreening (called HLAB*5701) can really reduce the risk of developing the characteristic side effect of abacavir; this strategy has actually changed out treatment decision making.
Hope this helps. BY
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