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Switching from Atripla
Apr 25, 2012

My doctor wants me to switch from Atripla because of the possible side effects to my kidneys. I have never had a kidney problem or have history of Kidney disease in my family, He wants me to switch to selzentry and epzicom. Is this a good combination to take to replace Atripla? I have had sucess with Atripla and Zigen and am not sure if I should switch. What do you think? Pete

Response from Dr. Young

Hello and thanks for posting.

Presumably, your kidney side effects from Atripla are due to the tenofovir, but not the FTC or efavirenz components. While generally uncommon, there is an increasing awareness of the risk of kidney injury from tenofovir, particularly among older people living with HIV. It's recommended that kidney function be monitored by checking urinary protein and glomerular filtration rate (GFR) on a regular basis.

Based on this, switching the tenofovir component makes sense to me and based on current US treatment guidelines, if you're HLA B5701 genetic test is negative, then switch to abacavir (or to the combo Epzicom/Kivexa) would be very reasonable. You can see from this that the most conservative switch is to go from tenofovir/FTC/efavirenz (Atripla) to abacavir/3TC (Epzicom) + efavirenz (Sustiva). Given that you did well on abacavir (Ziagen) in the past, there's no reason to think that you'd have any new side effects on this regimen at all.

Maraviroc (Selzentry) is an alternate 3rd agent that has been shown to be similar in effectiveness as efavirenz in two large studies (when combined with Combivir)- is very well tolerated, but does require twice daily dosing and special viral testing to insure that it'll be effective. There's little data on the combo of Epzicom +maraviroc, but understanding this, the combination should be effective.

I hope that's helpful, BY



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