Atripla and Alcohol: Interactions and What to do about it
Excessive alcohol intake has long been found to affect the success of HIV drugs. It has been linked to poor response to treatment and rapid progression of the disease.1 Alcohol can affect treatment success in several ways, such as promoting high-risk behaviors among HIV-infected individuals, negatively affecting treatment adherence, interacting with antiretroviral medications, and aggravating side effects.
Dozens of anti-HIV drugs have been approved since the drug’s discovery in the 80s. Highly active antiretroviral therapy (HAART) made HIV a conquerable disease, although a viable cure remains elusive. You can’t be rid of HIV once it enters and proliferates in your system. The only way to keep symptoms under control and prevent the disease’s progression to full-blown AIDS is by continuously taking antiretroviral medications. By July 12, 2006, the first one pill, once-a-day coformulated regimen emerge by the name Atripla. Since then, the once terrifying lethal disease is now susceptible to a range of approved regimens.
The single-tablet medication contains a non-NRTI efavirenz and two from NRTI class –emtricitabine and tenofovir. Efavirenz (EFV) is commonly referred to as “non-nuke;” it works just like the nuke class of antiretrovirals because they bind to the same enzyme. But EFV binds on a different site. This enzyme-binding activity blocks the virus from converting its genetic makeup into your immune cells, thus preventing it from replicating. Atripla must be taken on an empty stomach because food increases the plasma concentration of efavirenz, which also increases the frequency of side effects. Additionally, EFV is also known to cause neuropsychiatric effects, such as dizziness, abnormal dreams, and impaired concentration, among others. Taking it at bedtime may improve the tolerability of these symptoms.
The effects of alcohol on Atripla need to be explored further since efavirenz have been found to cause intoxicating or LSD-like effects. Patients who are taking efavirenz-containing meds can have a false-positive test for cannabis upon urinalysis. Alcohol can worsen the CNS side effects commonly experienced in Atripla. In one interaction study, it was found that efavirenz lowers blood alcohol concentration, but increases drowsiness or intoxication. Alcohol has no pharmacokinetic effect on efavirenz and ritonavir. Other statistically significant, but clinically irrelevant findings from the study include:
- Increase heart rate with alcohol and efavirenz administration;
- Small decline in diastolic blood pressure.
Effects of alcohol on treatment outcome
While there are no major interactions between Atripla and alcohol, binge drinking is still not advisable while you are on an antiretroviral regimen. Alcohol is linked to high-risk sexual behavior in both uninfected and HIV-positive individuals. 5 You may also forget to take your medication when you drink too much, which can result to drug resistance. Moderate drinking is fine, but alcohol abuse can cause problems for obvious reasons. It is also worth noting that HIV meds, like all medications, are filtered in the liver. Excessive drinking can impair your liver. If you are taking HIV meds, liver damage can be more severe. Alcohol is metabolized in the liver by CYP2E1 and CYP34A, to a lesser extent. The activity of these enzymes may be increased with chronic drinking.
Somehow, the major impact of alcohol aside from worsening side effects is placing patients at risk due to non-adherence to prescribed regimens. There is a commonly held belief that alcohol cannot be mixed with medications, thus some patients would choose not to take their meds while they are drinking. In a study presented at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), alcohol and tobacco use are linked to lower efavirenz levels. But the observation can only be applied to rapid metabolizers of efavirenz because of their genetic makeup. Patients with the CYP2B6 516 GG genotype, who smoke and drink, had lower CD4 counts and higher viral load. This is not surprising since heavy drinking has been associated with weakening of the immune system and increased susceptibility to infectious diseases.
Despite conflicting results from various studies, the best advice a healthcare provider can give to their patients is to drink in moderation and to never stop taking their medicines without doctor’s advice. Further studies should continue to examine the impact of alcohol on HIV medications to provide clearer evidence, so that the true effects and cost effectiveness of interventions created to prevent disease progression with alcohol use can be established.