Question
Should I stop Atripla if I have been diagnosed with cirrhosis?
20 June 2011. Related: All topics, Changing treatment, Complications and coinfections, Opportunistic infections, Stopping treatment.
I have been HIV positive since 1985 and been on anti-virals since the early 90’s.
Recently I was advised that I now have cirrhosis of the liver and am exploring the option of stopping Atripla as I understand it is quite detrimental to the liver, even though the damage has been done.
I have been speaking with a number of medical professionals here in the US, as well as other folks who have stopped taking any anti-viral therapy, with mixed results. Obviously, there are two very vocal camps with significant opinions on the issue of HIV/AIDS. Although it may pose some level of risk, I’m considering stopping all meds for a while and find out if I may be one of those that does well after stopping meds.
Opinions, advice and/or personal journeys through this issue would be much appreciated. Thanks much !
Answer
Even without knowing the details of your history – without which I can only write in general terms – I would be very careful before considering a treatment break. Also, this Q&A resource is based on providing information based on data, rather than giving advice.
Although most people think that combination therapy contributes to liver problems, the reverse is more likely to be true.
A very large study called SMART a couple of years ago showed that serious (including fatal) liver-related complications occurred more often in people who were NOT on treatment compared to people who were on stable HIV drugs. Part of the risk for liver-associated complications was believed to come from interrupting treatment (this was the purpose of the study) because after stopping HIV drugs viral load rebound very rapidly (within weeks). This viral rebound causes increases immune inflammation and activation and this in turn can worsen liver disease.
Finally, again from the SMART study, treatment interruptions were more serious in people with liver disease causes by hepatitis B or C.
Much better to key your viral load undetectable and if you are worried about one particular drug, to consider switching it for another. Having said this, the drugs in your combination have not been linked to liver problems, especially if you have been using them for many years without problems.
It would be more important to try and find out what else could have lead to cirrhosis and your doctor should be able to help work through the possible options.
This will also talk about your previous and current drug history in case there is a specific reason to suspect one of your current drugs is causing a problem.
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