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Should I switch to the new "Quad" pill?
Oct 21, 2012

Hello, and thanks for answering my question. I have been on meds for 12 years, doing very well for the most part. Viral load undetectable and CD4's in the 500's. I am currently taking Altripla. My doctor wants me to switch to the new "Quad" because he feels it might help lower my cholesterol, which fluctuates at around the 225 mark, and also lower my triglycerides, which are about 240. I trust him, but I haven't been able to find any data that shows this new drug actually has better results with lipids. What is your opinion? Thanks.

Response from Dr. Young

Hello and thanks for posting.

It's good to know that you've been doing so well after so many years on treatment.

Perhaps as suggested by your doctor, in HIV medicine, are goals are no longer just prevention of AIDS complications, but rather the long-term health and successful aging of people living with HIV. As such, we appreciate that many other medical issues, such as cardiovascular illness (CVD) could compromise these goals. To this end, having a complete understanding of your cardiovascular disease risks, especially those which are modifiable, is important.

For example, not smoking, getting a good diet and routine exercise can help prevent heart disease. Similarly, from a medical standpoint, controlling high blood pressure or diabetes is essential.

One's blood lipids (cholesterol and triglycerides) also are important CVD risk factors. Fat levels in the body are under the influence of your genes, diet, exercise and medications. The lipid goals depend on your overall heart disease risk. It's in this very last context that we should look at your question about switching from Atripla to Stribild (Quad). Presented studies show that people taking Stribild have a somewhat better lipid profile than those taking Atripla, therefore a switch from one to the other would be expected (though this specific study has not been conducted yet) to lower cholesterols. I wouldn't necessarily expect very large changes, but in concert with other means, might get your lipids into target ranges.

Stribild differs from Atripla in it's side effect profile (less of the psychological profile that efavirenz has) and also in it's requirement to be taken with food. It also has a different set of drug-drug interactions that you and your healthcare providers need to be mindful of when prescribing. Since both combo pills contain tenofovir, your kidney and bone health risks should be monitored.

I hope that's helpful, BY



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