Atripla resistance, work case scenario

[wanderer37]

Ok, so here is my situation and would appreciate advise: I have been traveling a lot recently and flew to the other side of the word, taking Atripla 11 hours later than normal to fit my bedtime in new time zone, then got ill the next day with a stomach bug and basically forgot to take it. Kicking myself for this mistake, I had taken atripla every single night at bedtime for the last year and not missed one until now. I'm really worried that the combination of the 11 hour switch, one tablet, then missing a day will cause resistance and it is over a month till I'm back home for a VL test . I love atripla cos it is easy to carry and once a day and I have been UD since last year. Really don't want to develop resistance.

[darryaz]

Atripla is much more "forgiving" than you think.  You didn't do anything that could possibly cause resistance.  Just get back into your routine and you'll be fine.

[newt]

As an occasional occurrence, this is zero resistance risk. Rest easy.

- matt

[wanderer37]

Thanks for the replies, feel better now

[wanderer37]

One other related question I wanted to post (the worst case scenario bit in the thread title) before but didn't in my blind panic of becoming resistant .....
What kinds of combinations are available to people who become resistant to Atripla for whatever reason? Has anyone been through this and still found a workable combination like Atripla?

Regards,
Wanderer

[newt]

Hello

You can't be resistant to Atripla as such.

You can develop resistance to the component drugs in Atripla (efavirenz, FTC, tenofovir).

This seems like a slight distinction but it is important, because how resistance occurs for each drug, and the consequences for future treatment, are different.

Resistance occurs when tiny changes in your HIV (mutations) allow the virus to evade the effect of a particular drug, or sometimes a class of drug. Some drugs will be useless with one/two changes, some require more.

The mutations which stop drugs like efavirenz working are different to the ones which stop FTC, tenofovir, PIs etc working. 

Therefore if you, by some route, get changes to your HIV that stops 1 drug in Atripla working, you can still use the other 2 and swap the dud med for another unaffected by the changes causing the resistance. This gives you many options.

If, by some event, you became resistant to all the 3 drugs in Atripla you could use a combination that is unaffected by the changes causing this. For example, an integrase inhibitor, or a PI, or a new drug from the same drug class as efavirenz designed to overcome resistance etc etc.

So even with resistance to the 3 drugs in Atripla there will be options.

And, resistance is a subtle thing. Even changes to your HIV that theoretically mean a drug is useless does not always translate into not being able to use that drug. << I will explain more if you like but this post is getting long

A while back there was a guy in New York with serious resistance, the press went mad at the idea of emergence of an untreatable, extra strong type of HIV. The guy was given a standard combination (Atripla), even though he was theoretically resistant to the drugs in this pill. It worked fine.... I guess they could have prescribed other drugs, but with resistance there is value in a try it and see approach sometimes.

- matt

[oksikoko]

And, resistance is a subtle thing. Even changes to your HIV that theoretically mean a drug is useless does not always translate into not being able to use that drug. << I will explain more if you like but this post is getting long

Just to add to the optimism, there was talk in these forums about the fact that TAF (the upcoming new and improved tenofovir) "may actually be active against some HIV strains resistant to TDF [old, I mean, 'classic' tenofovir] and other NRTIs, which means TAF absolutely needs to be studied and made available for individualized second-line and salvage regimens."

TAF: Will an Exciting New Gilead Drug Achieve its Full Potential?

So, even if you developed a resistant strain to the old tenofovir, the new one may still be available to you. Lots of 'ifs' and 'maybes' but it's better than 'no' and 'cause I said so'.

Lee

[atripla_2013]

Hi friends,

Thank you for your sharing. So I would like to have your advise about:

When we travel to another country where the time zone is changed a lot from day to night (from asia to EU) what is the best way to take pill?

In my opinion, we should take one pill more in the short time than missing 1 pill in a long time.

Please advise

[Jeff G]

Atripla is very forgiving so when you travel its perfectly OK to take the dose at bedtime
 ( or when what ever time of the day you take it ) to get back on schedule .

Changing up how you take Atripla is OK to do as long as you are not missing doses consistently . I was on Atripla for many years and used have to do what you are doing and remained undetectable .