HIV Atripla Life Expectancy: Research Review
Major improvements in therapy did not only give HIV patients another shot at life; it also doubled their life expectancy, at least for young people in their 20s. Atripla is one of the breakthrough medications from Gilead Sciences, which was approved in 2006. It is a coformulated single pill containing three different drugs: efavirenz, emtricitabine, and tenofovir disoproxil fumarate. Prior to Atripla’s emergence, patients were required to take multiple pills with multiple dosages daily. Adherence is paramount to achieve maximal viral control and stable immunologic status, as well as to prevent drug resistance—but the complicated treatment regimen threatens patient compliance. Those who are overwhelmed with the number of pills, and annoying adverse effects on the side, will most likely find it difficult to stick with the regimen or stop taking their meds altogether. In the eyes of many patients, an ideal antiretroviral therapy (ART) must have:
- High efficacy in research trials;
- Lower pill burden;
- Fewer or well tolerated side effects;
- Less frequent dosing.
Before the therapeutic goal of once-daily single pill regimen was achieved, Gilead already had Truvada, a combination of two potent drugs emtricitabine and tenofovir for treatment-naïve patients. The novel drug Atripla is a product of a major collaboration between the two pharmaceutical giants Bristol-Myers Squibb, which introduced efavirenz, and Gilead Sciences Inc. In a Swiss Cohort review, Atripla was the most frequently used ART from 2005 to 2008.
HIV life expectancy: then and now
Before the introduction of highly active antiretroviral therapy, experts estimated a minimum 10-year life expectancy for HIV patients. In 1996, a 20-year old HIV-positive individual was expected to live up to 39 years. Recent findings from Kaiser Permanente research stated that there was gap of 44 years in the life expectancy of uninfected people and HIV-infected patients in 1996–1997. Thanks to ART, the gap narrowed to 12 years in 2011. HIV-related deaths have also dropped from 78% in 1988–1995 to 15% between 2005 and 2009.
In 2012, a group of researchers used a stochastic computer simulation model to estimate the life expectancy and assess the effects of antiretroviral meds on a 30-year-old MSM patient, who was diagnosed in 2010. The study estimated a life expectancy of 75 years, assuming a 40% risk of the patient being a smoker and without a hepatitis comorbidity. If HIV did not occur, the life expectancy would be 82, which means a gap of seven years exists between patients with and without HIV infection. With proper treatment and strict adherence to their regimens, HIV patients are now expected to live up to 70 years. Using data from the study, the impact of HIV on patients’ life expectancy is now comparable to other chronic diseases like diabetes.
Another hope for Atripla
Though Atripla has paved the way for the development of more effective and less toxic antiretroviral coformulations, it has been replaced by newer drugs as recommended regimen for treatment-naïve patients. The downgrade was brought by high discontinuation rates and high incidence of CNS-related adverse effects, such as depression, abnormal dreams, and suicidal thoughts. But an ongoing 2016 study adds another potential advantage for the single-tablet regimen. The study, spanning 24 weeks, switched Atripla users with undetectable viral load from daily dosage to every other weekday or thrice-weekly dosage. Martinez and colleagues from the University of Barcelona conducted the concept study to 61 people who were currently on once-daily Atripla, with a CD4 count of >350 cells/mm3 and suppressed viral load of <37 copies/ml for at least two years. Participants were randomly assigned to one group taking daily Atripla and another group with three days a week regimen (Mondays, Wednesdays, and Fridays).
After 24 weeks, no participants in either group experienced virological failure. None of them showed a viral load of ≥37 copies/ml. Patients who were taking reduced dose also reported improved scores on Pittsburgh Sleep Quality index. Patient compliance was good and all participants completed the study. Participants from the daily Atripla group even asked to be placed in the three-day group. Because of the outstanding results, the authors requested the ethic committee to extend the study to three years. The study could be another game changer for the management of HIV since it validates the potential for therapy doses to be taken at least one day apart.