Atripla is an oral antiretroviral medication for the treatment of HIV-1 in adults and children weighing above 40 kg. This three-drug combination contains the Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor, and Emtricitabine (FTC) and Tenofovir Disoproxil Fumarate (TDF), which are two HIV-1 nucleoside analog reverse transcriptase inhibitors. Atripla represents a significant development in the treatment of HIV-1, as it was developed as a part of a joint corporate venture and is the first ever triple-therapy offering. It received approval from the FDA in 2006 and from Health Canada in 2007. Atripla is a convenient and effective antiretroviral combination product that is a natural fit for current HIV management guidelines. It provides a simplified approach to effective HIV management for patients and physicians.
Dosing & Administration
Current Canadian adult guidelines recommend the treatment of all HIV-positive patients with antiretroviral therapy. This includes treatment on an immediate basis during chronic HIV infection, regardless of CD4 counts, and during the acute phase of the primary infection with HIV. Antiretroviral therapy is especially urgent in cases of pregnancy, symptomatic infection, co-infection with chronic hepatitis B or C, higher viral loads, lower CD4 count, and other specific situations.
Medication compliance is especially crucial in HIV therapies because of rapid viral resistance development. Fixed-dose single-tablet combination antiretrovirals such as Atripla may improve a patient’s adherence to the drug regimen, which lends a significant therapeutic advantage to this combination medication.
Atripla is indicated for first-line use in drug-naïve patients, usually at a dose of one tablet at bedtime on an empty stomach. It may be used alone or in combination with other antiretroviral agents for the treatment of HIV-1.
Atripla should not be used in patients with moderate to severe renal failure, including patients with an estimated creatinine clearance below 50 mL/min. Additionally, Atripla should be used with caution in patients with mild hepatic impairment, and it should not be used at all in patients with moderate to severe hepatic impairment.
Atripla’s side effects include the following:
- immune reconstitution inflammatory syndrome, or IRIS;
- lactic acidosis.
The list above is not exhaustive. For more information on this medication’s side effects, refer to the product’s package insert.
- All patients should be tested for the presence of chronic Hepatitis B Virus (HBV) infection prior to starting antiretroviral therapy, including Atripla, due to reports of severe acute exacerbations of HBV after the discontinuation of FTC and TDF, both of which are contained in Atripla.
- Current HIV treatment guidelines recommend testing HIV-positive patients for the Hepatitis C virus (HCV) and regular ongoing testing for those deemed to be to high risk. If HIV/HCV co-infection is identified, consideration should be given to treating both infections concurrently.
Atripla’s key drug interactions are with Cytochrome P450 metabolized medications, but there is a long list of drug-drug interactions that should be reviewed in the package insert prior to prescribing.
Pregnancy & Lactation
Atripla may cause neural tube defects, so it should not be used during pregnancy. Any inadvertent use during pregnancy should be reported to the Antiretroviral Pregnancy Registry. Pregnancy testing in female patients of child-bearing age should be done prior to the initiation of treatment with Atripla, and effective birth control should be used during therapy with Atripla and for 12 weeks after therapy with the medication.
In the case of an overdose with Atripla, monitor the patient to see if there is any evidence for toxicity. Apply standard supportive treatment. For more information about what to do in case of an overdose with Atripla, refer to the medication’s package insert.
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