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changing from isentress prezista and norvir to Atripla

Feb 3, 2017

hello I would like to ask if I can use Atripla instead of what am currently using which is isentress prezista and norvir as I sometimes dont get them and end up missing half a month's dosage or more and they are expensive I used Atripla 10 years ago then I was foune to be resistant to evifavirenze but I presume the resistance has faded I would use Atripla for 3 months then get a viral load and cd 4 test done to confirm if the drug is working.

Response from Dr. Young

Hello and thanks for posting.

In short, no.

If your virus was once resistant to efavirenz (Sustiva and part of Atripla), it will still be resistant. For life. That's one of the key reasons why it's critical to be adherent to meds, since viral drug resistance generated to medications often confer resistance to other medications, and will stay with you (and that damn virus) for life. Even if you don't see the resistant virus in your blood stream, as the resistant flavors will remain archived in infected cells, like bad books in a library.

That said, it's certainly a good time to assess (or reassess) the medications that you're currently taking. You definitely don't want to miss part of your medications at any time, as this is an excellent way to generate additional drug resistance. At a minimum, this means proactively working with your pharmacy to anticipate when they need to get you medications; ask if they can synchronize your prescription refills, so that you get all of the pill bottles at the same time. Consider asking for 3 month supplies- it'll mean 1/3 the possibilities of a supply error.

There are also likely ways to decrease the number of medications you take, as one can use a fixed-dose combination of darunavir (Prezista) with a different boosting drug, cobicistat- in the combo pill Prezcobix. Indeed, Prezcobix and dolutegravir (Tivicay, a relative of isentress with greater potency against resistant virus) could be a two-pill, once-daily regimen with the same, if not greater potency of your current treatment. Two prescriptions could mean one less fewer chances for a pharmacy error. I'd suggest asking your provider if this is an option to treat your virus.

I hope that's helpful, BY



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