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atripla VS.Quad
Feb 3, 2013

Hi Dr. Young. I been diagnosed since 2006 it was undetectable(i dont know exact number i been avoiding clinic but i am back now) I guess through last 2 years medication progress and now Dr's feeding everybody pills low or high counts. I am very skeptic about Quad coz it been on market only since 2011 (if i am wrong plz correct me) i think its not enough time to know what exactly it does to body. Both pills have horrible side effects. Been browsing webs and I think if my counts are still low undetectable I will chose not to take pills. If I decide to take Quad or Atripla does these meds triggers lipoatrophy?? If your best friends daughter gets sick what pill would you suggest to take and how soon after diagnoses? What is the best clinic in US?

Thank you so much for your answers and help.

Response from Dr. Young

Hello and thanks for posting.

Current US treatment guidelines (widely regarded as some of the most stringent in the world) recommend treatment for nearly all HIV-infected people, irrespective of CD4 cell count. I don't feed people pills for no reason, I do so because of the preponderance of scientific data shows decreased illness, improved health and decreased risk of death.

It's reasonable to be skeptical of things- but do understand that Stribild, like other medications, has to pass review by both the FDA (and other national regulatory agencies) as well as the peer-reviewed scientific process. No single aspect is perfect, nor is any single medication perfect for all people, but this is the usual process by which we learn of the strengths and limitations of medications. I'd recommend the thoughtful and individualized selection of HIV medications to my friend's (or mine , if they were positive) daughter, or granddaughter. I'd recommend that they start treatment as soon after diagnosis as they were ready to be adherent to medical follow up and pill taking- but not to wait to start until they got sick or had loss of immune function. However, like shoes, there isn't one best medication regimen for all people. The choice is based on a range of issues, including the virus resistance pattern, health and lifestyle of the individual.

Both Atripla and Stribild (Quad) are generally very well tolerated HIV medication regimens- I wouldn't call their side effects horrible at all; for some the side effects are unacceptable, but for the large majority of people, these two offer very well tolerated and safe regimens. Stribild was FDA approved last year following several years of study.

The clinical trial that compared the two medications side by side was published last year in the Lancet. There's limited data about lipodystrophy about elvitegravir, but this class of medication (integrase inhibitors) is not thought to be associated with significant additional risk of fat changes. In an earlier large clinical trial, efavirenz (part or Atripla) was associated with more fat changes than the boosted PI Kaletra. The other parts of the two combo pills (tenofovir and FTC) are generally believed not to play a significant role in body fat changes. It would be worth checking out AIDSinfonet.org or AIDSinfo.nih.gov for more information about the individual HIV medications of interest.

If your viral load is undetectable, you might be in the lucky category of long-term non-progressor. Having a low-detectable viral load likely means that this isn't the case; but in both conditions, monitoring your CD4 count (at least annually) will help keep a check on the state of your immune health.

As for the "best" clinic in the US- there are many. First off, the best clinic is one that you can reliably and consistently get too; one that also has a medical staff that you trust and can communicate with in a non-judgmental way. Failure to stay retained in medical care is a strong predictor of unwanted health outcomes and medical complications. I'd start by asking your local community (or AIDS-service) organization about their recommendations. Ask the care provider if they're trained in HIV medicine or certified by the American Academy of HIV Medicine- these are minimum benchmarks of education; also ask others (including patients) about their experiences.

I hope that helps. Be well, BY



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