Q and A

Question

I have questions regarding adherence and research….

Hi there,

First I would like to say thanks for the assistance provided on this website. All the answered questions, help, advice, and feedback is greatly appreciated.

My question (its kinda 2 questions actually) is regarding adherence, and then regarding research.

1. I take Atripla and have been respondnig to it very well thus far. I take it at the same time everyday but lets say once a month or so, when I’m out with friends I may take it about two hours late or so? Is that gonna cause any problems? I imagine it would not since I’ve read that Atripla has a good half-life and also read somewhere that Atripla can be taken up to 12 hours late (which I would never do, but just stating what I read). So for example if I take it at midnight everyday, than take it at 2 or 3 am once every month or so, I’m wondering if that will cause any problems? I have yet to miss a pill and don’t think I ever will actually, until some advanced treament comes along.

2. Second question is regarding research and future of meds, vaccines & potential functional cures. I have read about the recent breakthroughs and exciting research going on like the Dermavir patch/vaccine, the CMV vaccine that cleared SIV in monkeys, the PRO 140 once every two week injection, Sangamo’s gene therapy, the Berlin patient, etc and many other good reads. I know that me, you or anybody can’t predict the future but how likely do you think there will be some sort of big change in how HIV is treated in the next 5-10 years? And do you think there will ever be a time in the coming years where we can control the virus without the need for daily meds? Your opinion would be greatly appreciated.

Thanks a lot and keep up the good work.

Answer

Thank you for your question.

I will answer according to the numbers you have given:

1. Obviously the closer you take your medicine to the allocated time, the better. However, the general rule is that you have an hour either side of your allocated time to take your meds. Being a little bit late once a month with an undetectable viral load shouldn’t do you any harm.

However, it is not good t take Atripla 12 hours late. This is because of resistance but also because of side effects. Taking Atripla 12 hours late means that there is only 12 hours between the late dose and the normal dose. If someone takes Atripla and then 12 hours later takes it again it means the levels of drugs in their body are too high and this can cause side effects. For more information and for a more detailed explanation please follow this link to a similar question.

2. There are definitely some exciting things happening in areas of research into alternative forms of treatment. At a major HIV conference this year a group presented findings of an unusual study to increase CD4 levels in people with continually low CD4 counts. This was just an initial experiment but plans are underway to try this on a larger scale and look into the possibility of trial participants then stopping ARVs to see if the high CD4 count can then suppress the virus. This is a very exciting study but it is still early days. For more information please follow this link.

There is also some interesting work which is going on looking at using nanotechnology. Drugs developed with nanotechnology would need much lower drug doses (hopefully cheaper and having fewer side effects) and would be longer lasting (perhaps being taken every2–4 weeks). For more information please follow this link.

4 comments

  1. Simon Collins

    Hi Simon

    Thanks for your comments and for sharing your experiences.

    I also thought the Sangamo studies were interesting and was at the conference earlier this year where the results were first shown. Here is a link to one of my reports if you are interested in my take on it.

    Once your viral load has been undetectable for six months or so, as long as you continue taking your meds, it is very unlikely to develop resistance or ever rebound. This should help you not to worry too much about this aspect of treatment.

  2. Marcus

    Hi Simon. Thanks for the reply.

    I have read about the Atipla “FOTO” study previously (though it was a small/medium sized study, it still showed excellent results) and I agree it shows how strong of a drug Atripla is. Of course anyone that is reading this post should consult with thier doctor before adhering to their meds in such a way, whether its to reduce pill burden, cost or other factors.

    I was diagnosed in the earlier part of the year and started med a few months after. So far so good and my my number are great so far. At first when I was diagnosed I was really scared adn confused and didnt know much about HIV…..no more than the average person. I thought and asked about life expectancy, side effects, living a normal life, relationshsips, having kids etc. and overall thought it was the end of the world. I of course now realize that is not the case these days with this chronic manageable virus especially when you are living in a developed country and have access to the care, doctors, medication, insurance etc and whatever you may need to help you to continue to live (all of which I have).

    I’m in my early 20’s now and hopefully that in the coming year that maybe we may not even need medication anymore and may be able to control the virus with whatever new type of treatment will arise. A very fascinating study that I have recently read about is the gene therapy study by Sangamo BioSciences, who are based out of Los Angeles in the USA. It is a study which has is similar to the Berlin patients procedure, but less instense. They remove the CCR5 co-receptor from a blood cells and put them back in the patient, so these cells are immune to HIV and of course expand in the body. This has caused the patients CD4’s to skyrocket which is very good news, especially this early. The study is still in its early stage and more results are expected by the end of the year.

    Just as Charlotte mentioned, one of the results that we are all awaiting from this study is to see if the high cd4’s stay overtime and to see if it has an effect on decreasing and/or supressing viral load as well…. Hopefully this does the trick, since this has worked in an animal model previously. Of course lots of work still needs to be done and many questions need to be answered but its good to see how much has happend in the world of HIV/AIDS in only a span of 30 years, and what more is to come. We went from people dying regularly, to people living near/normal lifespans.

    As for now, I do stick to my Atripa adherence 100% and have yet to miss a pill. I take it the same time every night and rarely take it a few hours late if Im not home, or an hour or two early if I’m going to sleep early. With that said, I did read as well that if I can supress the virus, adhere 100%, that resistance is nearly impossible? I know already that I do not have any strains that are already resistant and any med on the market will work for me. But of course since Atripla is considered the best and and easiest to take, Im sticking with that and hopeful that resistance does not develop for any other reason.

  3. Simon Collins

    Thanks Marcus.

    Going back to your original question, being late by 2-3 hours once a month if you are on Atripla is likely to be fine. The three drugs in Atripla have long half-lifes, which mean they are all likely to remain over the minimum target 3-4 hours past the usual time you would take your meds.

    I also agree that the FOTO study provides good supporting evidence that the odd missed dose of Atripla is unlikely to have any impact on risk of resistance. See:
    http://i-base.info/qa/3828

    The information on the link you included is for missed doses, not for safety of routine dosing. Frequently missing by 12 hours could increase the risk of resistance – best always to aim for one time, and a few hours either side will be fine.

  4. Marcus

    Thanks for the quick and informative reply Charlotte. I appreciate it a lot. :)

    “If you miss your dose, you can take Atripla up to 12 hours late. Otherwise, take your next dose at the regular time.”

    http://www.thewellproject.org/en_US/Treatment_and_Trials/Anti_HIV_Meds/Drugs_at_a_Glance_Atripla.jsp

    This is what I was referring to in terms of the 12 hour thing. And another I’m sure you have read is about the FOTO study a few years back. where patients would take Atripla on weekdays and take wknds off. And they were still able to suppress the virus and be undetectable. It really shows how strong this drug is.

    Hopefully that nanotechnology use comes into play soon. It sounds very exciting.

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