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Follow up question to "Atripla as second line regimen?"
Nov 12, 2013

Dear Dr. Benjamin, On November 7, my question "Atripla as secondline regimen?" was posted on your site. My sister's first line regimen was combivir and sustiva. Her second line regimen was first abacavir and didanosine. Then a year ago this was changed to abacavir and lamuvidine (ritonavir/lopinavir). Last month it was again changed to atripla and lamuvidine. How do you assess this combinations? Your prompt answer is highly appreciated.

Response from Dr. Young

Hello and good to hear back from you.

In order to really fully understand your sister's situation, it would be important to know why the treatments were changed- if there were side effects or suspected treatment failure.

Nevertheless, the switch from Combivir+Sustiva to abacavir+didanosine+(?)Kaletra suggests to me that her doctors suspected treatment failure of the first regimen. As such, it's quite likely that her HIV may be resistant to some of the medications in the first regimen, most probably the Sustiva (efavirenz) component.

If this were the case, then Atripla is not a good option, as efavirenz is part of this regimen.

I've got concerns about her doctors' knowledge of treatments, for if she is really on Atripla + lamivudine, this is not a recommended regimen. Emtricitabine (part of Atripla) and lamivudine are essentially the same medication and their coadministration isn't recommended (not for toxicity, but redundancy).

Hope that helps, and feel free to write back. BY



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