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Switching from Atripla to Complera
Apr 7, 2012

I have been taking the Atripla combo for the past 4.5 years with great success. I immediately became undetectable from a viral load of 171000 and my cd4% has risen from 10.5 to 35%. I currently take the 3 parts of Atriple because the country I live in does not yet have the single Atripla or even Emtriva. In anticipation of Atripla coming here I've been buying the Emtriva abroad and paying full price for it. Now to my surprise I have learned that Complera not Atripla will become available here (and totally covered by insurance). Am I crazy to consider switching from the extremely successful Atripla combo to Complera in order to save $425 per month? If I did switch to Complera and had problems is it possible to switch back to Atripla without causing somekind of resistance. Would a switch to Complera somehow limit my future options? Thanks for your advice!

Response from Dr. Young

Hello and thanks for posting.

A few thoughts:

First, if it will save you money, you might consider using generic lamivudine (Epivir) instead of emtricitabine (Emtriva). These two medications are roughly equivalent, and the former is now generic in many parts of the world, whereas the later isn't (and more expensive).

Second, yes you could consider migration to a Complera regimen, though understand that Complera has a different set of requirements for food and drug interactions than efavirenz (part of Atripla). There's less data on switching to Complera regimens, particularly in persons who (like you) start with high viral loads and low CD4s, but I work under the assumption that this is likely ok.

If for some reason you don't tolerate the Complera, you could switch back to the Atripla regimen, provided that the reason for switch wasn't viral resistance. In this later case, there's a much more involved set of considerations, including drug resistance testing that would have to be done.

In the end, one needs to weigh how much benefit having a 1 pill a day treatment is versus continuing a successful 3 pill per day regimen is to you. In my doctoring world, I see both sides of this argument; in my personal world, I don't necessarily think that the 2 pill difference alone warrants a change, but but if there are other issues, such as side effects or improving adherence, then these added potential benefits might offset the small risk in the change.

I hope that helps, BY



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