Question
Will I have resistance from these missed doses of Atripla?
15 July 2011. Related: All topics, CD4 and viral load, Changing treatment, Resistance.
Hi,
When I was first diagnosed HIV positive, I suffered from anxiety and was neurotic about my regime. Since I have had therapy and become more accepting of my HIV, I have become more relaxed and careless about my meds. I have been missing a dose of Atripla about three times a month on average.
Now, I am currently trying hard to improve my adherance, but I am worried that I have already developed resistance.
My viral load was undetectable the last time I got my blood results. My pharmasist says I will most likely have a rise in my viral load count, but that it will not necessarily mean I have developed resistance. I find this confusing as I thought a rise in my viral load count would mean I have developed resistance.
Do you think I still have a chance to change my adherance before it’s too late to continue with taking Atripla?
Answer
Hi
Please see this similar Q&A. The reference and link to the FOTO study is an example of why you may still be okay.
Because the three drugs in Atripla take a long time to leave your body, if you miss three separate doses each month, the drugs levels may still keep the virus suppressed without developing resistance.
If you are missing three consecutive days in in a row – then your risk is more serious, and trying to get back to better adherence is important. At the end of the third day you would be a risk of resistance much more easily. If your viral load rebounded after these longer breaks, then it is likely to be with resistance virus.
Also, think about why your feeling changed. Accepting your diagnosis and yoru successful response to treatment, means you can think about a normal lifespan again. In a funny way that can also be strange after the shock of a diagnosis where you think a lot about mortality.
Because of the way you are worrying, I’m sure you will be able to get this back under control again. It is good that you feel confident to have these open discussions with your pharmacist.
Cohen C et al. The FOTO study: The 48 week extension to assess durability of the strategy of taking efavirenz, tenofovir and emtricitabine Five days On, Two days Off (FOTO) each week in virologically suppressed patients. 5th IAS Conference, 2009. Abstract MOPEB063.
http://library.iasociety.org/AbstractView.aspx?confID=2009&abstractId=3046
Hi Victimsaccomplice,
The initial study only included 61 participants. They had also had undetectable viral load for many years. Entry criteria on to the study included viral load <37 copies/mL for more than two years.
Here’s the i-Base report from October 2016.
The three drugs in Atripla give most people flexibility to miss odd doses, maybe a couple of doses a week, but a much larger study would be needed to know whether anything less than this is really safe.
This study was also in a country with easy access to frequent viral load tests. More importantly, if the treatment did fail in some people there are lots of choices for the next combination. This is not the same for many people.
There is a study with Atripla where patients took Atripla only 3 times a week (Monday, Wed, Friday) and maintained undetectable viral load in the long run. Fear mongering works up to a point, nothing beats science though. Yeah. You can miss Atripla 4 times a week (Tuesday, Thursday, Sat, Sun) and remain undetactable.
Hi Kelly, Sorry, it sounds like this is a tough time for you. But unfortunately we are not doctors. So it’s important that you talk to the doctor to find out about your treatment. Having lymphoma can mean that you need to see a specialist doctor because of possible interaction with your HIV meds. You can ask the doctor if you are getting this special treatment for lymphoma and HIV.
Hi
My doctor stopped me from triple for 6 weeks reason being she is trying to treat lipoma as im having round moon face buffalo hump as was results from previous combination of ARV’s which was including stavudine . How dangers am I facing from this?
Hi Neos, the pills will be okay. Most medicines – especially hard tablets – stay fully active for a long time after the date on the box. There isn’t a mechanism for the active drug to suddenly disappear. On set of evidence for this came from a warehouse of wide range of medicines that had been stored for use by the US military. Even though these were 15 years out of date, 90% of them still contained the right levels of active drugs. Soft capsules are slightly less stable – especially to extreme temperatures – but six months for tablets will be fine. See:
http://www.wsj.com/articles/SB954201508530067326
Can you please answer me …
I am on atripla one and half year till now ( since I found out that I am HIV positive)…
Till now I had really good adherence to my meds and I have never missed a single dose , but now , last 4 monts I get old medicines .
Actually , from my clinic they are giving me a 2 pills regimen : 1 pill that contain Tenofovir & Emtricitabine , and 1 pill that contain Efivarenz.
The pills that contains Tenofovir & Emtricitabine are with 6 months exp. Date .
And the efivarenz pills have still valid date .
I am scared if the reason that Emtricitabine – Tenofovir pills are with exp. Date can affect my health and low down my cd4 count .
Plus I am coinfected with chronic HBV ….
Is the date of the pills so important for the efectivity against the virus , or it does not have any reason to worry .
From my clinic are telling me that there is no reason to worry if the date of the pills is still valid or not … They try to calm me down , but after all they say if I am scared to take an exp. Date pills , they can help me to buy them by myself ( private ) . But the cost of these pills is 7OO eur (that I can not afford it since the country where i live the average salary is 15O EUR )
Please , I am waiting for your answer and your advice …
Hi Joe,
It’s not good to have to skip doses. Is this because your doctor has not supplied enough tablets? There’s a risk of resistance with most drugs if you skip 4 doses a week. That can mean the drugs won’t work against HIV. What drugs are you taking?
It’s really important to ask your doctor or clinic to supply enough tablets for you to get through the week without having to do this. You could ask for tests to see if there’s been a viral rebound. It’s important to ask about changing treatment if this has happened.
Do you have treatment support where you live?
There have been times when I have less tablets to go for a week, and I have skipped a day in between for four times in a week to make sure the medicine goes for that week. How will this affect me? I get scared of resistance.
Without knowing the antibiotics you have been prescribed,
You can check this online using this drug interaction resource from Liverpool University.
You can use the charts to highlight the drugs in Atripla – efavirenz, tenofovir and FTC and then look for either individual antibiotics or at the class (called antibacterial in this resource).
Generally antibiotics do not interact with these HIV drugs, by some TB medications can interact with efavirenz.
Can I take antibiotics with Atripla.