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Atripla, sleep disturbance, and switching
Nov 10, 2010

Hi,

I was diagnosed almost exactly 1 year ago and put on ATV/r+Truvada almost immediately as my CD4 count below 200 and CD4% was below 10%. The viral load dropped very quickly from 50,000 to less than a hundred in 2 months. However, it failed to reach undetectable. It turned out that I have L33I and L33F mutation, which undermined the effectiveness of ATV/r.

My doctor then switched me to Atripla and my VL went undetectable almost immediately. I never have any strange dreams with it. However, gradually I realised that my sleep pattern is getting worse and worse. Now I usually wake up after 2-3 hours of sleep. Even when I manage to sleep through the night it would be a very light sleep, similar sleeping on a long haul flight, and I don't wake up feeling refreshed.

I have now been on Atripla for 5 months. Do you think the sleep disturbance will go away? Or should I consider switching the next time I see my doctor? I am worried that if I do switch I will use my third combination within 1 year and I will run out of options quickly.

Response from Dr. Henry

If your dreams are getting worse after 5 months then I would not be confident that that issue will improve with more time. In some cases patients have tried taking the Atripla in the morning and see how that is tolerated. Some sleep meds can be helpful on a variable basis. If AM dosing doesnt help then often would consider alternative to efavirenz in your regimen (such as ritonavir boosted darunavir or raltegravir). KH



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