Hi Dr. Henry, I have a question and I would appreciate your opinion. I have been taking Atripla for the past 3 years and it has been working great as far as controlling my Hiv infection. My labs have been great my V.L has been undetectable for 3 years and my T- cells have increased. I do not have any resistance to any medication at this time, but find that Atripla has given me some Neurological issues. I have problems falling asleep, some if not most nights, and with that find it hard to concentrate on tasks during the day. I also find myself feeling foggy at times during the day.

My question is do you think its time for me to switch meds or should I tough it out. I am paranoid that if I switch meds I will be using up a line of medication before I need to switch. Atripla has been the only medication I have ever been on. My ID doctor has told me that I should switch if I am having these issues with Atripla. My ID doctor told me that a good alternative to Atripla would be Isentress plus Truvada. My doctor told me that Isentress is a good alternative and has a low toxicity profile. I was also thinking about Reyataz/Norvir + Truvada. I would appreciate any feed back from you and what you thought would be my best options.

There are many good choices to switch off an effective regimen in situations such as yours. I have had many patients switch to either of the two regimens you mention and they have done fine. If you want once a day the Reyataz regimen might get the nod while I concur that the raltegravir based regimen (currently twice a day dosing) has been very well tolerated. There is no head to head comparison between the two switching options-they are both good choices. KH