Hello Doc,..

I've been on Atripla for a year, with undetectable VL and CD4 280(20%). Due to an issue of false positive marijuana test from efavirens and that is really a problem for me to apply for a job, I'm considering to switch to Isentress+Truvada.

My questions; - Would that be safe for me to switch to Isentress straight away or should I do any certain tests before that? - Twice daily for isentress, is that mean i should take it every 12 hours or can i take that at 9pm and 6am? -What is the worst side effect from Isentress with your patient in your clinic? is that true that isentress is could cause kidney damage and rhabdomyolisis?

My next appt. in 2 weeks time and I need your opinion as well

Please help

Thank yo so much

Hello and thanks for posting.

Both efavirenz (part of Atripla) and raltegravir (Isentress) are parts of recommended first-line regimens in current US treatment guidelines. In general, in patients without resistant HIV and when paired with NRTIs can be highly effective and well tolerated.

In our hands, raltegravir is very, very well tolerated; rare persons report difficulty sleeping, we've not had a single clinical case (though lab tests will occasionally detect) muscle irritation (but not the more severe rhabdomyolysis).

There are no particular tests one needs to perform in order to switch, and dosing need not be so rigorously timed- just twice daily (I usually tell patients to take in the morning and evening, without trying to specify the times or time interval between doses).

I hope that helps; let us know how your treatment goes for you.

BY