Complera v Atripla

[monarcmarc]

Hi Guys,

I had a follow up appointment today with the clinic. They didn't take my blood work last time, and I wanted to clear up some questions in relation to swapping my regime. Unfortunately, there was a nurse there rather than a doctor, which is a bit annoying for me because while she's very knowledgeable, I wanted to discuss my concerns with a doctor.

I have been doing a bit of reading on Complera, because she said that if she had anything to do with it, that would be the change that she preferred. I read a little bit of info on Complera aimed at Prescribing doctors and I had some questions which I plan to ask the doc, but until then I thought I'd throw them out here in case anybody has some answers.

There were 2x96 week trials on complera. These were on treatment naive patients. Obviously some of the results may not be applicable to me since I am undetectable on Atripla, but the results still leave some questions in my mind. If anybody has any reading they can direct me towards or answers, I'd love to hear from you.

1st, there was increased virological failure in treatment naive patients with a VL load above 100,000. My baseline prior to commencing on atripla was about two and a half times this. Do you think this means that complera may not be as effective at controlling my virus? I read a conflicting report which seems to indicate that where you're at UD, switching presents no problems.

The reason this concerns me is because the 96 week trial results indicated that where there is treatment failure, their was a significantly higher incidence of resistance to other drugs in the in the same class, or even the whole class when compared to efaviranz (Atripla.)

I also found that a bit disconcerting given that the component the swap out for efavirenz, riviliprine(?) doesn't have quite as long a half life Atripla. I like the fact that I can vary the time I take Atripla by a couple of hours without too much cause for concern. Will this be the same for Complera, or will I need to be a bit stricter and set a time each day to take it, or is the difference negligible?

I'm sorry to keep banging on about the change, but the reading is what it is and I'm not knowledgeable enough to understand the nuances of it. I don't want to be swapping it out, only to swap it back, or to develop a resistance that is nastier than it might have been otherwise. As much as the quality of life can be a bit of an issue, at the moment I'd be more inclined given the above to stay where I'm at than to switch up. If my concerns though aren't really warranted, then I'd be prepared to just switch and see whether it works for me. I just don't want to be switching and causing myself unnecessary angst in the process.

Cheers
Mark

[buginme2]

I think I can answer a couple of your concers.  I also recently switched from Atripla to Complera.  The switch was uneventful.  All the Atripla side effects stopped and I finally got a good nights sleep in years.  The only real pain with Complera is you have to take it with a meal (at least 400 calories) which can be a pain in the ass sometimes.  Oh and Complera can and does cause gas.

Ok. Regarding the half life.  Rilpivrine actually has a longer half life than Efavirenz.  So no you don't have to take it at exactly the same time.  I don't think I have ever taken it at the same time from one day to the next.  http://en.wikipedia.org/wiki/Rilpivirine

While Complera was only approved for treatment naive patients.  There was a study done that examined whether it was effective for people switching from Atripla to Complera.  The study was presented at ICAAC in 2011 and found that everyone in the study that switched maintained an undetectable viral load.  Here is the study;
http://www.natap.org/2011/ICAAC/ICAAC_23.htm

Since there was actually a study done on the switch doctors are more likely to switch you to Complera than Stribild since there hasn't been a study yet for that switch.

Regarding the viral load.  I don't know.  I do know that when I switched my doctor checked my records to see what my very first viral load was when I was diagnosed (13,000) and then prescribed the Complera.  I feel like if it had been over 100,000 he probably would have switched me to something else.  He didn't specifically say that, but why else check what my first vl was.  My hiv doctor is pretty well regarded and I would value his opinion, again he didn't specifically say why he checked it though.

[monarcmarc]

Thanks for info. Heartening to know that rilpivrine has a longer half life, and precise timing isn't really something to be worried about.

It's also nice to hear of your experience re sleeping, I was a bit hesitant when I saw that one of the most common side effect of Complera. I am having difficulty getting to sleep, but it's not debilitating but I would like to be in bed before 1am and I find myself staying awake longer to try and dose straight off.

I am trying to get some exercise in as well to help with this, especially in light of the higher blood pressure (140/80) they recorded, I've typically had low blood pressure.

Complera is probably the best option for me, as I've limited financial resources available to me while I study. The extra script if I were to take a seperate combo of two or even three different pills would be difficult for me to afford, though it might have to be something that I have to consider and make room for in y budget. Having said that I'm very lucky that the government funds much of my medication.

Re the viral load that your doc checked for, do you know whether it was the vl on diagnosis or was it baseline prior to commencing treatment?

[buginme2]

Re the viral load that your doc checked for, do you know whether it was the vl on diagnosis or was it baseline prior to commencing treatment?

I started treatment right away so I only had one viral load test done pre treatment.  Since my cd4 was less than 500 I began treatment.  My vl on diagnosis is my baseline.

After switching, I can tell you I would never switch back to Atripla (unless of course I had to).  I didn't have major problems with Atripla but Complera is so much less intrusive.  It has so little side effects that sometimes I question whether its working because I can't "feel" it working like I could with Atripla.  With Atripla you can tell that you've taken the pill, with Complera you take it and forget it.  Oh, and the pill is smaller.

[monarcmarc]

Thanks for that.

I was able to touch base with my old doctor this morning and she tends to think complera is a good option for me in the circumstances. Viral load and resistance are non issues when you have and are successfully controlling the virus. Good news.

I still have a couple months of atripla to take and that roughly coincides with when I can expect to see the New doc again, so I will take out the end of the prescription and switch over.

Did you find the meals difficult to adjust to? 400cals seems like a significant serve. The complera website had some good information around what to eat which is really useful.

I'm looking forward to the change, change of routine aside. Thanks again for sharing your experiences

Mark

[monarcmarc]

I did have just one more question, in your experience was the difference noticeable immediately for you or did you experience a few of the previous side effects, however minor while the sustiva wore out?

Mark

[bufguy]

According to this link rilpivirine has a shorter half life than efavirenz  http://www.thebodypro.com/content/68833/switching-to-rilpivirinetenofovirftc-fixed-dose-co.html

Although seen as an alternative to Atripla for people who have side effects to efavirenz, the CNS events are only halved rather than eliminated, and there are important differences between the FDCs that are often not communicated to patients: the rilpivirine-based FDC needs to be taken with a 550 calorie meal; efficacy in naive patients is reduced when baseline viral load is greater than 100,000 copies/mL; and the shorter half life of rilpivirine compared to efavirenz doesn't support a wide flexibility in dosing time.

The FOTO study (five on two off) showed in a very limited sample that Atripla could be take only 5 days a week with weekends off due to the long half life of the med especially the efavirenz component


I've been lucky in that I've had no Atripla side effects. Although an older med, many doctors still think of it as the gold standard