HIV Support Group

I began treatment with similar time/years and lab numbers as you. And I have had very similar side effects to you. In the beginning they can be very, very scary. You are not alone. Unfortunately Efeveranz, one of the drugs which makes up Atripla works on the central nervous system - and it's the only HIV drug that can interfere with our thoughts. They say that the side effects can diminish after 4 weeks or so (with luck). And for the lucky ones there are none!

But for a lot of people the side effects are so severe that they just simply have to stop the drug. It is a very popular first line of therapy and it's success, despite the side effects are well documented. But we aren't laboratories. But I have to say that my viral load is now almost undetectable and T - Cells have risen. Clinically it has worked without a doubt, however the side effects have been so severe this success has been over shadowed.

If you search this site you will find several postings by myself and others about the side effects from Atripla. It took about 10 - 12 weeks for the side effects to subside for me (to a tolerable level). If things are intolerable you can switch at the beginning to Nevirapine (Viread) and Truvada.

I decided to stick it out, I also went overseas for 8 weeks and didn't want to take on board any new unknown side effects from a new drug. Unfortunately when I returned home I have been hit once again by the side effects. I had no side effects while on vacation just when I returned. Who knows why. No doctor can explain this. But then again very few doctors have ever taken Atripola themselves. Again I think Efeveranz plays on stress and our thoughts as it crosses the brain barrier.

Everyone recommends you take the pill "just" prior to sleeping, hoping that you will sleep through the initial side effects. For me about 2 - 3 hours after taking the pill the electric "buzz" begins. I am now familiar with this side effect, but in the beginning it really spins you out when you wake up. What is horrible is taking the pill and not going to sleep (a morning dose). You can hardly speak it's like taking weird speed or something - just awful. Another recommendation is to take Atripla on an empty stomach.

I would recommend that you take a sleeping pill about 15 mins before bed. And then take the Atripla pill just as you get into bed. I would do this even for a couple of weeks to see if things will settle. This was also the advice of several specialists. It will definitely make life easier. Xanax however interacts with the Efeveranz in Atripla.

Atripla is a combination of Truvada and Efeveranz, and if you decide you can't stand the head trip anymore, a HIV specialist recommended that I take Truvada and Intelence - and remove Efeveranz altogether. This will mean two pills a day. Some people just can't tolerate Efeveranz - simple as that.

Unfortunately for me right now, (and I began in September last year), I am still suffering from waking with buzzing electricity through the veins or just unable to sleep, even with the sleeping pills. I have really persisted, probably far too long. So I have depression, (linked to) insomnia and then fatigue during the day. It's a cycle I'm trying to break.

Above all be kind to yourself. There are many different drugs to take, so see if you can't tolerate Atripla, don't despair there are numerous other combinations. At www.thebody.com is an excellent site where you can ask HIV specialists and doctors questions directly, it's excellent.

Please contact me anytime for advice, as I have asked a lot of questions about Atripla. Lots of luck from Australia.

I have had near the side effect experiences you have had on Atripla. I take mine at night just before bed with amytriptilene to help me sleep. They say if you take it at night, you don't notice the side effects near as much. The amytriptilene is a good safe sleep med.

hello,
I began taking Atripla a week ago and I had similiar symptoms. The first two nights I slept really deep...no hallucinations, but vivid dreams...and then I was super dizzy all day. I spent two days in bed because I couldn't get up from the dizziness. It took about...well, a week I guess...to lose the extreme dizziness. I work nights 3 days a week. The first night I had to work and take it, my arms went numb, I couldnt move and my pupils doubled in size...it was horrible! The only complaint I have now is when I work I get feverish for a few hours after I take it. I still get dizzy 30 minutes later, but its not as bad anymore.

Anyways you are farther along than I am! I felt great the first couple of days, just super dizzy. Now I am kind of tired a lot again. But I have to give it another couple of months.
My CD4 count was 257 and my viral load was 159,000...so hopefully this will help!

Anyways keep it up, I am! I think it will get easier as we go along. My dreams are much more vivid now though which is kind of nice I suppose. I was promised erotic/nightmarish dreams, so far I have only had normal ones in HD.

i take Atripla, and have done for around 6 months now. Initially, because I work shifts, I decided I would take it first thing in the morning. This usually works fine, but I cannot have anything to eat for a couple of hours after taking it. The reason for this is the side effects, namely feeling like I am drunk.

My doctor recently explained that the more fat content foods have, the greater the side effects.

Now I only take it just before going to bed. I have only 2 known side effects and that is funny dreams, not nightmares just very vived dreams. Before I took Atripla I hardly remember having dreams. The other side effect is wind...mainly in the morning...lol - it has woken me up before.

That said...the side effects that I know of are manageable for me, and with my VL dropped to undetectable within a month of taking it Im happy with the progression so far.

Got my first set of blood results in August that should show a significant change in CD4 count.

I've just come off Atripla and moved back onto my original combination of Norvir, Reyataz and Truvada. Atripla was making me weepy and depressed. Gave it a good try though for almost two months. Feel so much better now that i'm not taking it.

I have been on Atripla for 4 days now. It is by far the worst experience I have ever had, I want to give in and just quit taking it so bad. on 6/26/09 my CD4 count was 270. In 02/15/09 it was 530 my doctor waited a while before giving it to me and she said my CD4 count will go back up. I feel crappy when I wake up in the middle of the night, i feel crappy when I wake up in the morning. I don't like to take it on an empty stomach. DOES anyone have any tips on what I can eat to help with the upset stomach?? Lord I hate this medication!!

I started with Atripla with a viral load of 1.46 million and CD-4 of 100. Took the med at night before bed. Viral load now undetectable and CD-4 about 380 and rising. I am also on ambien to help me sleep. The side effects do slowly disappear for the most part. Without ambien I cannot sleep. Take the meds, have your doctor do blood tests for liver and other things every few months. A great drug so far. One pill a day for the rest of your life is a small price to pay. If you don't take it regularly, there is a danger of the virus adapting to it and not being affected. So far so good. Remember what the chances were only 5 or so years ago. Life expectancy before the cocktail was what, about 1 - 2 years?

Im not too bad on it had a rough few days at first but doing fine now apart from what i can only describe as a daily hangover in morning but wears off as day goes on I been on it 6 weeks and life is good apart from lost my mum suddenly last month which didnt help the old immune system or the support network but hey the trick is keeping strong and dont stop unless you really cant hack the side affects because you will become resistant to it.... wish u good luck xxx

Gradually increasing efavirenz doses during the first two weeks of therapy with the drug reduces the incidence and severity of neuropsychiatric and sleep-related side-effects without compromising the effectiveness of the drug, Spanish investigators report in the August 4th edition of the Annals of Internal Medicine.

Efavirenz (Sustiva, also in the combination pill Atripla) is a widely used anti-HIV drug that is recommended for first-line antiretroviral therapy.

Although the drug has a powerful anti-HIV effect and is easy to take, it can cause neuropsychiatric and sleep-related side-effects including dizziness, depression, nightmares and insomnia. Up to 50% of patients initiating therapy with efavirenz report these side-effects. Although they are often only mild and generally go away after a few weeks, they are more severe in a small number of patients and, in some cases, have been linked to suicidal thoughts.

It has been suggested that these side-effects are connected with levels of efavirenz in the blood. However, data supporting such a hypothesis are currently lacking. Nevertheless a dose-ranging study conducted early in the drug’s development showed that the incidence of neuropsychiatric side-effects was lower amongst patients taking the 200mg or 400mg dose than those taken the now licensed 600mg once-daily dose of the drug.

Investigators therefore wished to determine if gradually increasing the dose of efavirenz during the first two weeks of treatment with the drug reduced the incidence and severity of neuropsychiatric side-effects.

During the first few weeks of treatment with most antiretroviral drugs, drug levels will be abnormally high until the body becomes used to metabolising the drug, a state described as 'steady state'. The high drug levels that occur during the early weeks of treatment are responsible for many early, transient side-effects of treatment. The use of a lower lead-in dose to reduce side-effects is established practice with nevirapine (Viramune).

To evaluate the effect of lead-in dosing of efavirenz on side-effects, the Spanish research group designed a prospective, double-blind, randomised study involving patients starting HIV treatment for the first time, in Andalusia between 2006 and 2008.

A total of 114 individuals were recruited to the study. Of these 60 were randomised to take stepped doses of efavirenz. This involved taking a 200mg dose between days one and six inclusive, a 400mg dose between days seven and 14 inclusive, and the standard 600mg daily dose from day 14. The remaining 54 patients took the full 600mg dose from the outset. Both groups of patients also took two nucleoside reverse transcriptase inhibitors (NRTIs).

The safety and effectiveness of these two treatment strategies were assessed over a six-month period. Furthermore, on entry to the study and then on days seven, 14 and 30 the patients were asked to complete two questionnaires to determine the incidence and severity of neuropsychiatric and sleep-related side-effects.

The virological efficacy of both stepped and standard treatment was also assessed and plasma levels of efavirenz were monitored in a subset of patients.

Overall, 55% of patients developed neuropsychiatric or sleep disorders during the first week of therapy with efavirenz. However, a higher proportion of patients taking the 600mg dose of the drug from the outset experienced such side-effects than did individuals who took stepped treatment (66% vs 47%, p = 0.04).

Moreover, in the first week of treatment with the drug, individuals taking stepped treatment were less likely to report dizziness (33% vs 66%, p =0.001), feelings of drunkenness or hangover (21% vs 46%, p = 0.008), concentration problems (9% vs 23%, p = 0.038), and hallucinations (0% vs 6%, p = 0.056), than were patients taking the full dose of the drug.

During the second week, similar proportions of patients in the stepped and full-dose groups experienced neuropsychiatric and sleep problems (49% vs. 58%), but these tended to be less severe amongst patients taking stepped treatment.

Four weeks after starting treatment with efavirenz, 52% of patients still reported some neuropsychiatric or sleep disturbances, and overall 7% of patients discontinued treatment with the drug because of these side-effects.

Similar proportions of patients taking stepped and full-dose efavirenz had an undetectable viral load at all study points. This was also the case when the investigators restricted their analysis to patients with a baseline viral load above 100,000 copies/ml.

Two patients taking stepped treatment and four taking full-dose therapy experienced a sustained rebound in their viral load. A significant association was found between non-adherence and virological failure (p = 0.001).

CD4 cell increases were comparable in the two study arms.

The sub-study examining plasma levels of efavirenz found that, as expected, these were lower during the first two weeks amongst patients taking stepped therapy than those taking full-dose treatment (p = 0.047). No differences in plasma levels of efavirenz were observed 30 days after starting treatment. Patients with higher concentrations of the drug during the first week of treatment were slightly more likely to report dizziness, but this finding did not reach statistical significance.

“To our knowledge, this is the first randomized clinical trial directly comparing the incidence of efavirenz-related neuropsychiatric adverse events of efavirenz treatment given in stepwise doses with that of full-dose efavirenz treatment given from the first day,” write the investigators.

They conclude, “stepped-dose administration of efavirenz over two weeks significantly decreases the incidence and severity of neuropsychiatric adverse events, while apparently maintaining the same efficacy as the standard schedule.”

Reference
Gutierrez-Valencia A et al. Stepped-dose vs full-dose efavirenz for HIV infection and neuropsychiatric adverse events. Annals of Internal Medicine 151: 1-9, 2009.


http://www.aidsmap.com/en/news/579...

Well, I finally was getting over thr general side effects of Atripla.... then I got a severe Rash and it quickly spread all over. I look like I have chicken pox. I went to my Dr. the next day and she said stop taking Atripla... She is going to start me on 3 meds next week. I am bummed and depressed about the whole thing, but hey...Idk