Atripla, a recommended first-line regimen in antiretroviral treatment, is widely used, highly effective, convenient and generally considered safe and well tolerated. But a significant minority of people taking efavirenz – an ingredient in the all-in-one Atripla pill – experience neuropsychiatric symptoms that may include insomnia, vivid dreams or nightmares, and depression or anxiety. A new study has evaluated outcomes amongst people with HIV who switched from Atripla to Eviplera, a similar once-daily single-tablet coformulation that substitutes a newer NNRTI, rilpivirine (sold separately as Edurant), for efavirenz. “Switching Atripla to Eviplera led to significant improvement” in central nervous system (CNS) adverse events and improved sleep quality scores whilst maintaining virological suppression, the researchers concluded. “Identification of individuals with efavirenz toxicity is essential, as alternative agents can lead to significant improvements in toxicity profile and quality of life.”
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