Atripla - 3 week interuption after 8 yrs UD - Risks?

[Pepino2]

Hi guys,

I ran out of my meds and am on vacation out of the country..and the cost to refill is exorbitant so I prefer to wait till I get home in 15-20 days.  Iv been on Atripla (first regimen) amd UD fpr 8 years.  What are the risks?  Will I die?  Will I develop a resistant strain? Will I never be UD again?  Please keep it real and factual.  What does the current science say on this?

I trully appreciate. 

Thx everyone.

[Jeff G]

Its a horrible idea to take a drug holiday but if you must its better that you stop cold turkey and not miss doses here and there .

I had to take a drug holiday from Atripla and had no trouble getting back to undetectable again on it but every body is different . Best of luck .

[mecch]

You've been on successful treatment for 8 years and you still have a fear that you will die -- because of 3 weeks without your treatment?  Keeping it real, right.

Also, I dunno, but after years on meds, one would think a person has figured out to how to keep enough medicine around to avoid such unfortunate breaks. A long holiday was planned for in advance, no? 

Apologies for saying two negative things but your situation and response did get me thinking..   

I bet you will be fine -- just check in with blood tests when you get back on your treatment -- and there are plenty plenty of treatment options if for some bad luck atripla would be now crossed off the list.   

[Miss Philicia]

I'm not sure why people don't understand this, but when you develop resistance it means to a specific HIV medication, NOT ALL OF THEM. Hence why geno/phenotype tests are done.

[AusShep]

Actually, developing resistance to either an NNRTI or NRTI, (it's driving me crazy that I can't remember which one and google isn't being nice to me right now) can lead to a failure of all drugs in that class due to the similar mechanisms they use.

Have to agree with Jeff that drug holidays are horrible ideas and should be avoided if possible.

Pepino2, can you manage to get refill and file a claim for reimbursement when you get back?  I know that isn't an option in many cases.

[buginme2]

  Will I die?  Will I develop a resistant strain? Will I never be UD again?  Please keep it real and factual.  What does the current science say on this?

Let's keep it real.  If you were that worried you would go home and take your meds.  Will you die? Are you for real?

[Pepino2]

Jeff: Thanks, for sharing your actual experience with this situation.  I also think that stopping cold turkey at UD level is much less risky than spotty adherence at less then UD levels.

Mech:  Apologies accepted, I'm happy that my thread got you thinking, other than with your hands.

Miss Philica:  Thank you for this information.

AusShep:  Thanks for your input and concern.  Thinking of it as a "Horrible Idea" makes it sound as if I woke up one morning and decided to take a drug holiday.  Not the case.

For those that this might interest, I'm from Canada and was expecting my generic Atripla from India to arrive at a three month cost of $450.  Well, its late....and the price here for a 30 day supply is $2100.  No I don't have insurance and that is beyond the scope of this post.  Between a $2100 cash outlay and a 15 day hiatus after 8 years UD on an extremely effective anti retroviral, I choose to spend the hiatus....Champagne and Caviar too.

I'll be glad to update you all on my deep dive.

Pep

[AusShep]

Sorry you took my quote of/agreement with Jeff the wrong way.  I certainly don't think, and didn't mean to imply that you were making the decision haphazardly.


As to the actual facts and current science you initially asked for, since I didn't find it at first.  The class wide drug resistance I mentioned to Miss P can happen with any class but happens most often with NNRTI's.  Researchers on a very recent study also footnote that even with future viral suppression they believe the data suggests that there may be still some class wide resistance present that could appear later leading to virologic failure, but given the current low VLs they can't be certain.

[mecch]

AusShep - just checking. You are the + right?

[AusShep]

AusShep - just checking. You are the + right?

Yep.  Have had fun times with PCP, MAC, CMV, encephalitis, thrush, oral hairy leukoplakia, dermatitis, Bell's palsy, and other fun stuff like PICC lines and running IVs at home a couple times in the past, could probably come up with more if I keep thinking about it...  Doing fine and VL < 20 now.

[mecch]

Geez. Well welcome to the Forum, seems like you have a lot of great knowledge to share.

[guitargal]

how are you doing? doc took me off meds and messed me up..by the time i got the new doc and second opinion and new meds almost 3 months went by.

i am angry... i listened to him. i trusted him..

stay on your meds if you can …and never take a holiday for a long time.

there is a warning on Abacavir..look for it. if you stop and re start serious issues.

[Ann]

there is a warning on Abacavir..look for it. if you stop and re start serious issues.

Just to clarify for the newbies here...

Abacavir is not in Atripla.

It IS in Epzicom which is composed of  abacavir and lamivudine. In some countries Epzicom is called Kivexa.

It is also in a new triple-combo pill called Trii, which is dolutegravir + abacavir + lamivudine.

It's also in a triple-combo pill called Trizivir, which is abacavir + zidovudine + lamivudine. Trizivir isn't prescribed very often these days.

Abacavir is also called Ziagen. Ziagen is the brand name, abacavir is the generic name. Brand names of drugs are always Capitalised, while generic names aren't unless they are at the start of a sentence.

There is a test that most people are (should be) given before being prescribed abacavir. It looks for an inherited gene (HLA-B*5701) that indicates whether or not a person will have a hypersensitivity reaction to abacavir. It's the people who test positive for this marker who absolutely cannot re-start abacavir - and really shouldn't take it in the first place.  You can read about abacavir by clicking here.

You can read about other meds mentioned above by clicking here and finding them on the list.

[eric48]

doc took me off meds and messed me up..

Hi,

there are only very few people who relate their experience with treatment vacations etc. (obviously, since most posters are serious about their meds)

Therefore it would be nice if you could elaborate about

messed me up..

In what aspects did things go wrong?

Eric

[newt]

At 20 days cold turkey off Atripla there may be a 50% chance of total resistance to the efavirenz it contains. It is probably less than this, i.e. 0%, since efavirenz stays in the body at a non-resistance permitting level for 3 weeks for 90% of people. Hence the maybe 50% or 0%. This will only be noticeable on restarting the meds i.e. you do not go undetectable again. There is practically no chance of resistance to the other two drugs in Atripla, tenofovir and FTC.

In any case, expect to be undetectable again, on Atripla or another combo, and no you will not die (or get ill).

- matt

[eric48]

At 20 days cold turkey off Atripla there may be a 50% chance of total resistance to the efavirenz it contains.

If you stop cold turkey (i.e. suddent stop) and restart Atripla (EFV+TNF+FTC) there  may be a X , let's say 50%,  chance of total resistance to the efavirenz it contains.

That mostly because of EFV, I suppose.

The Aidsmeds drug page on Sustiva (EFV) (and same on NVP) explains users stopping meds (outside the context of an immediate switch) should tapper : stop EFV and continue the backbone NRTIs for, say, 2-3 weeks)

This reduces the risk X by a factor of 2

Unfortunately:
- Atripla users do not have molecules in separate pills (unless they have a spare EFV + Truvada (=TNF/FTC))
- the Aidsmeds page on Atripla doesn't mention this (while it does for EFV and NVP)
- Doc will explain patients how and why to start, how and why stay adherent, but not how to stop

If they have a chance, users who are at risk of drug shortage (yes, that happens.... See Greece...) should build a spare of the Atripla AND of componenets i.e. 2-3 weeks worth of EFV + Truvada (=TNF/FTC), knowing that their EFV stock will thus not be used.

I wonder why this is not explained in details, especially in Aidsmeds page/lessons. I understand why the manufacturer would not (eventhough, I do not read Atripla 's label on a regular basis) and why Doc would not. It might be complicated to explain without people getting confused, but, educated users may, if they face shortage, reduce their risk by a factor of 2. Maybe I am getting it all wrong ...

Worse, I read recently that EFV (or NVP) users , who had been instructed to GO OGFF meds in the SMART study , had not been explained HOW to do it in the safest fashion ... (I have re reference for this but not with me now)

Thus, I would hope that a patient oriented set of instruction be coined and published by authoritative site like Aidsmeds

Furthermore, I wonder if the same applies to other drugs with low genetic barrier such as EGV (found in Stribuild) ... We should ask... or look into the clearance time for EGV

That being said, even if resistance to EFV emerges, 50 % of patients (having this resistance) restarting Atripla, will nonetheless be able to re-suppress

Side note and reminder for NVP (Viramune) users (even if this is not the subject of this thread) : they should tapper (down) on stop and also tapper up on restart.

Another side note: (not the subject, but was mentionned by GuitarGal) the manufacturer label for ABACAVIR says that patient who have had a hypersensitivity to ABC should not be rechallenged to ABC.
In some countries with lesser option, they still rechallenge with a success rate of 50%

I hope I am clear enough and not confused myself (been smoking stuff a lot recently)

Eric