switching from Atripla to Triumeq

Question

I was diagnosed HIV+ in June 2008 and have been taking Atripla since then. I have been consistently undetectable with a CD4 of between 800 and 1000. Cholesterol 184, great HDL and good blood pressure. I have been 100% adherent and I have had no side effects. A recent bone scan did show I have osteopenia, but kidney and liver function is fine. I read where Atripla is no longer considered a first line regimen...Do you find any compelling reasons to switch to triumeq? or since Atripla seems to be fine should I just stay with it? Are there any long term issues you see with Atripla? Thanks for your advice.

Answer

Hello and thanks for posting.

Current HIV treatments are generally very well tolerated and very safe, so discussions about differences now are getting finer and finer precision- Atripla was just recently demoted from the vaulted recommended DHHS regimens, not because it has been found to be more toxic, per say, but rather that newer combinations offer even better safety or tolerability.

Triumeq is one of those newer regimens... all three medications in Triumeq are different than those in Atripla, so offer possibilities of different side effect or toxicity profiles. The main difference is that Triumeq uses the newest integrase inhibitor, dolutegravir in place of Atripla's efavirenz. The former is extremely well tolerated and has no diet or time of day dosing restrictions. The later (efavirenz) is associated with many psychological side effects, and should be taken at bedtime.

Triumeq also substitutes abacavir for the tenofovir in Atripla. Both drugs are nearly always very well tolerated and while abacavir has a risk of allergic reaction (which is predicted by a genetic test, called HLA B5701) and some feel may increase risk of heart disease, tenofovir is associated with increased risk of kidney and bone disease. A new (still investigational) form of tenofovir, called TAF, is associated in clinical trials to be associated with less bone and kidney problems than the current form.

If you're not having any side effects from Atripla and only have mild bone problems, there's no urgency in switching medications; some people do enjoy not having to link their medications to time of day or food, so in that regard, Triumeq may offer something for you. In our clinic, among people starting treatment, integrase inhibitor regimens like Triumeq (and Stribild and Isentress-containing regimens) have replaced the once widely prescribed Atripla. Our experiences have been uniformly excellent and tell us that like the clinical trials results and recent US treatment guidelines, that #HIVtreatmentswork, are indeed even better than in the past, and maintain health.

Hope that's helpful, BY