Two missed doses of Atripla within a week

[HandyAndy]

Ok, so I've been living with HIV for 8 years, however this is my first time ever seeking advice or posting in a forum. I guess I find it difficult to talk about it (still) and prefer to try and deal with things myself.

I've been on Atripla for almost all 8 years and have always been undetectable since 1-2 months on the drug.  Occasionally I've missed a dose here or there (very limited numbers in 8 years) but it has never resulted in a raise of my VL.  However, this last week or so due to work schedule, tiredness etc. I've missed two.  I missed one on a Friday evening and didn't remember until late the next day so just took my next Saturday night dose, and then the following week on Saturday (8 days later) I missed another - same situation.

I know that after years on treatment missed doses can become more common so I'm ensuring that via alarms on my phone and a 7 day pill box, I never miss another dose.

Here's the thing though - these two missed doses are causing me huge amounts of anxiety and stress.  I'm suddenly really paranoid that my VL will no longer be undetectable, and even though I'm not due for my screening until September, I have organised an interim for next week to hopefully put my mind at ease.

Now I know it varies from person to person, but would be interested to hear the likelihood of this happening, from experience. 

It's strange because I've never let HIV control my life - I've just taken my pills and for the most part not thought about it. But these last few months, after years of dealing with this - I feel suddenly burdened by the whole thing.  Call it mid-life crisis, approaching 40 - I don't know. While close friends know, I don't think I can ever talk to them about it to the point they would understand and I know no-one else with HIV.

[terpie82]

Having been on Atripla (or it's singular components) for over a decade, although rare in occurrence, I too had lots of anxiety/stress when missing a dose. Atripla, because of its side effects, had to be taken at night before bed. Some of us have had those long days at work, come home, grab a quick bite, collapse in bed and wake up the next morning with the horrible 'morning after' feeling that we forgot to take our meds. I discussed this concern with one of my physicians and he suggested I switch to another combo that doesn't require me to take it before bed. With this new combo, if I miss a dose, I can still take it in the morning when I wake up. If you have the same concerns I did with Atripla, perhaps discuss it with your physician and see what he/she suggests as an alternative.

[nathanieltroy]

Hi mate. I don't think it'll change your VL or cause another problem. Don't you have your doc's phone number or e-mail address to ask about this kind of emergency situations?

[Expat1]

Atripla is very powerful.  There was a small study exploring a 5 days on 2 days off with atripla.  And the results of this small study were published.  Take a look and relax.  You're OK and you're going to remain being OK.
Risks and Benefits of 5 Days On/2 Days Off in the FOTO Study

 
Mark Mascolini
 
People who took a weekend break from their regimen of efavirenz, tenofovir (TDF), and emtricitabine (FTC) made it through a 24-week study with the same viral control rate as people who took those antiretrovirals 7 days a week [1]. This small, intriguing trial took a novel slant on the goals of planned treatment interruptions.
 
The idea behind FOTO is that all three drugs in the regimen have long half-lives--perhaps long enough to sustain viral suppression over a 2-day drug break.

Note this was a small study with a very select patient group for a limited period of time.  Not suggesting that anyone try this on there own.  Just that it indicates that you are going to be OK with the occasional missed dose of Atripla. 

1. Cohen C, Colson A, Pierone G, et al. The FOTO study: 24-week results support the safety of a 2-day break on efavirenz-based antiretroviral therapy. 9th International Congress on Drug Therapy in HIV Infection, November 9-13, 2008, Glasgow. Abstract O214.

[NY2011]

i've been skipping every other Friday night (and sometimes Saturday night) for almost a year and I'm still 100% UD.  I did it because I am concerned about long term effects on the kidneys and liver. Look into the FOTO study.  My dr. mentioned it to me when I initially expressed concern and it's worked well.  I believe that it's the sustiva that has an extremely long half-life.