Question about Meds: How long can you stay on Atripla

[Guest guest]

, I don't think there is any reason to think Atripla will quit working for your after a set period of time if it is effective at suppressing your viral load when you start it and you have good adherence (miss doses very rarely or never.) This is particularly true of a combo like Atripla that is very effective at suppressing viral load below detectable levels. The main reason people stop using Atripla is because of side effects of Sustiva, which usually occur (if they occur at all) during the first couple weeks of therapy and diminish over time. I don't think there are any studies that would show Atripla failing over time in people with effective viral suppression and good adherence, assuming you had no resistance to any of the component medications of Atripla: Sustiva, Viread, and Emtriva. If you are having side

effects from Sustiva after a few weeks on it and they are not diminishing, then you should discuss with your doctor a change in medications. There are a number of other good first line therapy options, but they will involve more than one pill, and may involve more than one dose per day in some cases. Even if Atripla works fine for you with no side effects, you and your doctor may want to change medications in the future, particularly if some of the more recently approved medications (such as Isentress) prove to have fewer side effects and better suppression over the long term. It's too early to know what the long term side effects of Isentress may be, but it's looking very good based on early reports. I've heard some doctors are using it for patients who can't tolerate Sustiva. Personally, if I had a regimen that was working with no side effects, I wouldn't change it for a drug whose long-term effects are unknown. Even if I did have side

effects, I'd probably try Viramune or one of the protease inhibitors with a track record, possibly boosted with Norvir, before I'd try a new drug. As researchers study other combinations of approved drugs, there may be other competitive one-pill combos that work as well or better than Sustiva with fewer side effects.