ASM Microbe 2016: Atripla 3 Times Weekly Maintains HIV Viral Suppression


People with undetectable viral load who switched from taking the Atripla single-tablet regimen (efavirenz/tenofovir/emtricitabine) every day to just every other weekday were able to maintain viral suppression for 6 months, and longer follow-up is planned, according to research presented last week at the ASM Microbe conference in Boston.

Fixed-dose combination pills have made HIV treatment more convenient, with several once-daily all-in-one regimens such as Atripla now available. Reducing the frequency of dosing even further would cost less, could reduce side effects, and could potentially promote better adherence; on the other hand, a non-daily regimen might make it harder to remember to take pills consistently.

Esteban Martínez and Jose Gatell from the University of Barcelona and colleagues conducted a proof-of-concept study (NCT01778413) to test whether simplifying treatment with Atripla to 3 days a week would be less toxic and able to maintain viral suppression. The component drugs in Atripla appear to allow for less frequent than once-daily dosing, they noted.

This analysis included 61 people with HIV who were currently taking once-daily Atripla with suppressed viral load (<37 copies/mL) for at least 2 years, a CD4 count above 350 cells/mm3, no history of virological failure, and no known resistance to efavirenz, tenofovir disoproxil fumarate, or emtricitabine.

Most participants were white men, the median age was about 48 years, the median CD4 count was approximately 560 cells/mm3, and most had undetectable HIV RNA using an ultrasensitive single-copy assay.

Study participants were randomly assigned to either stay on their once-daily Atripla regimen or reduce it to 3 days a week -- on Mondays, Wednesdays, and Fridays -- for 24 weeks. Plasma viral load was measured at baseline, 12, and 24 weeks in both arms, and also at 1, 2, 4, 6, and 8 weeks in the thrice-weekly arm.

The researchers also looked at measures of tolerability including sleep quality, as efavirenz can cause insomnia and unusual dreams, and bone mineral density and kidney biomarkers, as tenofovir can cause bone loss and kidney function impairment.


"Three-day per week Atripla in patients with sustained viral suppression is a feasible option that should be further confirmed in larger clinical trials," the researchers concluded.

Martínezsaid the team now plans to extend the study through 3 years to see if 3-times-weeky Atripla can be used as a long-term maintenance regimen.



E. Martínez, J Rojas, JL Blanco, JM Gatell, et al. Three-day Per Week Atripla in Patients with Sustained Viral Suppression. ASM Microbe. June 16-20, 2016. Abstract PW-029.