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Change to Atripla to save on medication costs and maintain undetctable VL
Sep 11, 2009

I've been positive 20 years. Meds for 19 years. Currently take Norvir, Reyataz, Viread, and Viramune - paying $120/ea med for 3 month supply. Resistance tests done last year only reflected resistance to AZT. VL is undetectable and T cell count is 400-500. Don't want to mess up a good thing but would like to try to reduce drug costs. Is Atripla an option for me?

Response from Dr. Sherer

Probably not, but you should talk to your doctor about it. It's not possible for me - without a complete review of your past treatment history, responses, past resistance tests, side effects, and other clinical information - to answer this question, but your doctor may be able to. In my experience, after 19 years of ART, virtualy all patients have received one or both of these drugs somewhere in the past.

If you ever had a K103N, Y181C, or other major NNRTI mutation, Atripla would not be an option.

If you ever were treated with an efavirenz or nevirapine-based regimen and experienced virologic failure, Atripla would not be an option. (Other names for these drugs that you might remember: SUSTIVA, STOCRIN, VIRAMUNE)

I see that you are currently taking Viramune, which suggests that your current physician believes it to be contributing to your regimen, but you could achieve full suppression with the other parts of the regimen, so that fact that you are on Viramine does not ensure full activity, or any activity, of nevirapine (Viramune).

Similarly, it is possible that you have had enough NRTI mutations in the past to compromise tenofovir (Viread). If you have or have ever had the K65R mutation, or you have had 3 or more TAMS including either the 41 or the 210 mutation, I would not rely on tenofovir to be fully active in an Atripla regimen.

But this is too much speculation. You and your doctor can review the records available to you both, and your memory of ALL past regimens and responses, and decide whether a trial of Atripla is worth the risk of virologic failure and drug resistance.

In my opinion, unless you have SOLID evidence in support of such a trial, its NOT worth it, and you should stick with what is currently working for you.


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