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Atripla vs. Viramune + Truvada
Jun 8, 2007

Dr. Wohl, I asked you about Atripla vs. Reyataz + Norvir + Truvada as first-line treatment options, and I detected a slight preference for Atripla. Id like to pose the same question for Atripla vs. Viramune + Truvada. Aside from dosing differences, what are the pros and cons of these two options in terms of side effects, efficacy and resistance development? Without the troublesome CNS effects, it seems that Viramune might be preferable over Sustiva. Thanks!

Response from Dr. Wohl

I do think the convenience of Atripla is hard to beat. However, clearly the drug is not for everyone - no regimen is - and there are excellent alternatives. As far as Truvada + Viramune, this would not be a first choice. Viramune is not as potent as Sustiva (a component of Atripla) also the drug is not recommended for patients with higher CD4 cell counts due to increased risk of side effects.

But, for those who start on Atripla and do not tolerate the Sustiva, Truvada + Viramune is a reasonable alternative. I would not generally start with this combo given the alternatives.

DW



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