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What's better than atripla
Aug 21, 2012

I like to take the latest and the best. Having taken sustiva and then atripla forever, I hear about these new quads and complera. Having decent tcells 650. and always <20, I dont even know if the sustiva affects my sleep. I dont get nightmares but I do toss a few times.. age 52. I know sustiva still fogs me out bec if I ever have to wake up in the middle of nite, or one time I forgot to take meds and took it at 8am. I felt so fogged out. So, I want to take only the best. complera isnt good enough for me. A new quad is supposed to arrive soon. Does it contain complera? Doluetgavir is an int inhibitor? is this good enough? what do you suggest. I've always been unded since taking meds around 1995? with epivir. zerit and viracept. lol.. thanks

Response from Dr. Young

Hello and thanks for posting.

Interesting question. There are several new options out there- the fixed dose tablets Complera and the soon-to-be FDA approved Quad. Then there's the other (and more established) integrase inhibitor, twice-daily Isentress. In the not-too distant future is the new once-daily integrase inhibitor, dolutegravir. We've seen initial clinical trials data that found dolutegravir to be very similar to Isentress in first line treatment, and a press release of the date from a second large study that suggests that in combination with 2 NRTIs, to be *superior* to Atripla.

Switching off of a working regimen should be done carefully being mindful of the potential risks (side effects, toxicity or even treatment failure) and the potential benefits (in your case, improved side effects). Your situation is particularly special because of the history of previous treatments. Do you have any history of drug resistance? If so, any switch must take this into account. If not, then I'd stick closely to clinical trials proven combinations (particularly those that are endorsed by treatment guidelines). I'd suggest looking over the most recent treatment guidelines, from the International AIDS Society-USA for more details about current treatment recommendations.

Complera is a combination of tenofovir/FTC (2 parts of Atripla) with the newer NNTRI rilpivirine. It has fewer of the foggy side effects that you rightly associate with efavirenz (part of Atripla).

The new Quad dosen't contain Complera per se, but rather replaces the efavirenz (of Atripla) and rilpivirine (of Complera) with the new integrase inhibitor elvitegravir (and the boosting agent, cobicistat).

Hope that helps. Be well, BY



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