New One Pill Choice for HIV Available

Recently, the FDA announced approval of a new one pill, once-a-day drug regimen for HIV: Complera.
What’s Complera? It combines rilpivirine (Edurant), a new HIV medication from the NNRTI class, and Truvada (tenofovir and emtricitabine), a commonly used combination pill. It will compete with Atripla, the other one pill once-a-day option (efavirenz and Truvada).
Is Complera better than Atripla? Complera’s effectiveness is “non-inferior,” meaning “just as good,” in people with pre-treatment viral loads less than 100,000.
Study participants with higher pretreatment viral loads (>100,000 copies/mL),were more likely to fail on Complera, however. Doctors call this “virologic failure.” If Complera fails to control your HIV, and viral resistance develops, it might also eliminate Intelence and Viramune as future drug possibilities. Doctors call this “cross resistance.” This is not a good thing.
Remember that viral resistance does not happen all by itself. The number one reason for a failing HIV drug regimen is missing too many doses.
Complera causes fewer central nervous side effects, such as dizziness and dreams, than Atripla. If you are experiencing these side effects from Atripla, Complera may be an excellent option for you.
There are some unique features of Complera that make it a bad choice for some. You must eat when you take it, preferably a high fat meal, to absorb it adequately. Drinking a can of Ensure was found to be inadequate.
It’s ALSO not absorbed well if you are taking acid lowering medications, such as antacids or Zantac. Prilosec (omeprazole) or similar acid blockers can NOT be used with it.
In the updated DHHS “Guidelines for the Use of AntiretroviralAgents in HIV-1 Infected Adults and Adolescents,” Complera is an “alternative” treatment for HIV, and Atripla is still “preferred.”
Complera is approved for use for people with HIV who have not been other previous treatements for it. Studies are underway to see if people on other HIV medications can be safely switched to Complera. The providers I work with are quite comfortable switching their patients to Complera if they are well controlled on their current regimen.
So what’s the bottom line?
Complera is a great new choice for HIV, but it will not replace Atripla. Complera causes less dizziness and dreams than Atipla. If you have a high viral load, tend to miss doses, eat irregularly, or take acid-lowering stomach medication, Atripla is still a better choice for you.