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Side effects Atripla vs. (Abacavir + Lamivudine + Efavirenz)?
Jul 23, 2010

Hello, I am an international student currently studying in the United States but that may eventually have to go back to South America. I was detected HIV last December, and I know the infection occurred last summer. I have been following my viral load that has been decreasing from 6828 (January, 2010) to 4134 (June, 2010), CD4 counts have gone up and down: from 408 down to 335 (April), I almost started treatment (but she bellow my dilemma on treatments), but when I took another test they went up again to 440 so I waited (June, 2010; the higher since I have been following them). I am 29, with no health problems, do not do drugs, smoke or drink; can I wait to start treatment? I am currently just taking supplements and trying to be as healthy as possible, feel healthy and I am really afraid the side effects of treatment would change that. Also, because I may eventually need to go back to South America I was wondering what is the difference in terms of side effects and efficiency between Atripla and a combination of Abacavir, Lamivudine, and Efavirenz. Those are the options I have here in the US and in South America respectively. According to my doctor in the US I can start Atripla while in the US and then change to the other medication regime in South America without any problem, but according to the South American doctors I should not start Atripla and then move a combination of Abacavir, Lamivudine, and Efavirenz. I am confused with this two issues, can you help me please!

Response from Dr. Henry

Most patients would do OK if switching from Atripla to efavirenz + lamivudine + abacavir (particularly if HLA B5701 negative). The major issue with starting efavirenz + lamivudine + abacavir is a higher rate of skin/hypersensitivity issues resulting in modestly higher rate of stopping/switching meds. Once a patient is doing well on Atripla (so tolerating the efavirenz) a switch to efavirenz + lamividine + abacavir (again if HLA B5701 negative) would generally go smoothly if done due to which drugs are available. KH



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