efavirenz, emtricitabine, and tenofovir DF
Class: Dual-class fixed dose combination; single dose regimen—nucleoside analogs (also called nucleoside reverse transcriptase inhibitors, NRTI or nukes) and non-nucleoside analog (also called non-nucleoside reverse transcriptase inhibitor, NNRTI or non-nuke)
Standard dose: One tablet ([600 mg] Sustiva and Truvada [200 mg Emtriva, 300 mg Viread]), once-a-day; on an empty stomach or with a light, low-fat snack. Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $1,465.54 / month
Manufacturer contact: Bristol-Myers Squibb,
www.atripla.com, 1 (800) 334–4486 and Gilead Sciences,
www.gilead.com, 1 (800) GILEAD5 (445–3235)
1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
Potential side effects and toxicity: Includes nausea, diarrhea, rash. See the drugs contained in Atripla: Sustiva, Emtriva, and Viread. Dose cannot be adjusted for people with kidney problems.
Potential drug interactions: See the drugs contained in Atripla: Sustiva, Emtriva, and Viread. Do not take Sustiva, Emtriva, Truvada, Viread, Epivir, Epzicom, Combivir, or Trizivir, while taking Atripla, since these medications are already in Atripla or have equivalent medications. Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; report symptoms of illness, such as shingles and TB, to health care provider.
Tips: Where to begin to sing the praises of Atripla? Atripla is a complete HIV treatment by itself—no other pills needed. And this is only one pill, once a day. It’s a first in HIV. A great benefit: the single med cuts the number of insurance co-pays. The medicines in Atripla can be very tolerable, or not, depending on the person taking them. It is well-tolerated in most people. Atripla, however, is not for everyone. Most treatment-experienced people, those who’ve already been on HIV therapy, may not be able to use it due to their having developed drug resistance, when medications may no longer work against the virus. Drug resistance most commonly occurs when people don’t take their HIV medicine as prescribed, but you may also be infected with a drug-resistant virus against which some of the medications in Atripla will not work. Because it is one dose once a day, it is important not to miss a dose. The separate components of Atripla have their various considerations: Sustiva cannot be taken during pregnancy, and use of Viread must be monitored in people with underlying kidney problems. In this combination product, the Viread dose cannot be adjusted. Therefore, Atripla should not be used in people with severe kidney problems. Please see package insert for more complete potential side effects and interactions. See the drugs contained in Atripla: Sustiva, Emtriva, and Viread.
The approval of Atripla was a landmark in the history of antiretroviral therapy, since we’d finally achieved a one pill, once a day regimen. We also did it without any compromise, since this combination has been a real winner in clinical trials. However, Atripla is not an appropriate choice for everyone. I discussed some of these issues in the Sustiva section. I also avoid Atripla in patients with kidney problems, because it contains tenofovir. Remember also that Atripla is a first-line regimen; it’s not intended for people who already have drug resistance.—Joel Gallant, M.D.
Atripla is the most widely used 3-drug fixed dose combination, combining Sustiva, Viread and Emtriva in a single pill taken once daily. For many it is the holy grail of HIV therapy, a powerful easy to use combination in a single pill. This works well in a great number of situations and it is close to being the most widely used initial treatment. One major limitation that concerns a fair number of people is that it is based on the use of Sustiva, which is fine if you don’t have the traditional Sustiva side effects of nervous system disturbances. If you do, it’s a difficult choice. Another issue is that Sustiva is strongly discouraged for women who might become pregnant. Almost everyone likes the idea of the single drug/once daily regimen. What Atripla’s success really means is that drugs should be combined in this way whenever possible for the sake of simplicity. To achieve this, manufacturers will have to do what Gilead and Bristol-Myers Squibb did to create Atripla, namely cooperate. It is very unusual for competing companies to combine their products in this way, but Atripla shows that it works and benefits both the competitors and the patients. —Martin Delaney