I've agreed to begin a clinical trial in which, if I am randomized to begin taking meds, Atripla will be my first choice. After nearly 8 years of infection, my CD4 is 899, and my viral load is undectectable (as of June 2012). I am also an alcoholic blackout drinker. I have tried both Campral and Antabuse in two separate unsuccessful attempts to stop drinking. As of my last appointment, I didn't have any liver problems or elevated liver enzymes. I have recently read about an injectable form of Revia. Would this be a good drug to try in my attempt to quit drinking? What interactions does it have with Atripla? Thanks for your help in answering this question.

Thanks for writing. I am glad you are doing so well controlling your HIV but I am concerned about your blackout drinking. That is, of course, a serious problem that affects your physical health and, potentially, your medication adherence. You don't mention if you have tried counseling and support (AA, SMART Recovery, etc) in conjunction with Campral or Antabuse, but in my experience they are a necessary component of successful sobriety.

In terms of Atripla, you need to speak honestly with your physician and research investigators about your alcoholism. You are correct that there is an injectable form of Revia (naltrexone), as well as oral tablets. Both work to block the "high" associated with alcohol and some other drugs. Coadministration of Naltrexone with each of the three drugs in Atripla has the potential for hepatotoxicity (liver damage) and should only be done with close medical supervision even though your liver is healthy.

Your best bet would be to get the drinking under control as it will only create all kinds of problems for you over time. If you haven't done so already, utilize the social support available through AA or SMART Recovery in addition to any therapies.

Good luck!

-David