Answered by:
Stuart D. Federman, PharmD, AAHIVP
Gateway Apothecary
Saint Louis, MO


As long as the patient is not having any side effects and is tolerating the medication well, there is no need to change medication. We now have four single tablet regimens: Atripla, Complera, Stribild and Triumeq. All of them have their benefits and not all regimens are right for each patient. When a provider is making the decision on which regimen to choose, there is a lot of information that they will take in to decide on which medication to choose for each patient. There currently are not any regimens that the provider can choose that are cookie cutter, used for all patients; some patients are unable to use a single tablet regimen.

The most important key to consider in switching regimens in a patient that has a suppressed virus is to continue to keep the virus suppressed and the patient to have minimal side effects. Individual medications co-formulated into a single tablet, which were already approved for the treatment of HIV, become favored by providers since they work really well and are safe and convenient. Single tablet regimens have been proven to increase adherence to medication, which lessens the pill burden on patients who usually need to take more medication. Adherence to medication helps reduce the risk of drug resistance and avoid treatment failures.

Atripla is the first ever single tablet regimen for HIV intended as stand-alone therapy. Atripla is no longer listed as a preferred regimen by Department of Health and Human Services guidelines for people just starting HIV treatment since the medication has more known side effects than other therapies. The medication works very well and has become the gold standard in clinical trials to compare new HIV medications. We know that Atripla has many side effects, with the most common ones being vivid dreams, a hangover type feeling and dizziness. It needs to be taken on an empty stomach away from fatty meals.

The next single tablet regimen that was approved by the Food and Drug Administration (FDA) is Complera in 2011. It is similar to Atripla and contains medications in the same class. Complera is better tolerated than Atripla. This medication was specifically formulated to decrease the side effects that Atripla has on the brain. Complera should not be started in patients with a viral load that is above 100,000 at start of therapy or a CD4 count less than 200. Complera has been studied in patients where the researchers switched patient’s regimens from a multiple drug regimen or an older single tablet regimen and patients had no issues changing to Complera. Complera needs to be taken with a full meal (400 to 500 calories) to reach full effect. Patients need to avoid antacids and proton pump inhibitors (PPI); patients who need daily antacid or proton pump inhibitors should choose a different regimen.

In 2012, Stribild became the third single tablet regimen approved by the FDA. It is the first medication that combined an integrase inhibitor with a backbone as a single tablet regimen. Stribild, also known as the quad, combines four medications together. Integrase inhibitors have started to become the go-to medication for treatment naïve HIV patients. Stribild contains a booster, similar to Norvir, which interacts with some drugs used to treat heart disease and needs to be monitored. Stribild has been studied in patients where the researchers switched patient’s regimens from a multiple drug regimen or an older single tablet regimen and patients had no issues changing to Stribild. Stribild should be taken with food, but does not have a caloric restriction. Stribild has been shown in clinical studies that it is non-inferior to Atripla and causes fewer central nervous system (CNS) side effects than Atripla. Common side effects are diarrhea, nausea and headaches.

Triumeq is the newest single tablet regimen, which was FDA approved in 2014. It is the first single tablet regimen that does not contain tenofovir, which can affect the kidneys. Triumeq is very well tolerated and contains a medication in the integrase class. Patients need to be tested (an HLA test) to let the provider know if the patient may have a reaction to the medication. Patients with moderate kidney disease are able to take this medication when previously they were unable to take a single tablet regimen. The common side effects are insomnia, headache, nausea and diarrhea.

Future single tablet options will include tenofovir alafenamide fumarate (TAF), which is an update on the current tenofovir disoproxil fumarate (TDF) currently found in Viread, Truvada, Stribild, Complera and Atripla. TAF bypasses most of the side effects of TDF. The new co-formulations should be able to be used in patients with moderate kidney disease.

Another single tablet option in the pipeline would be the first single tablet regimen that contains a protease inhibitor (Prezista), co-formulated with TAF. This will help patients who have advanced disease or are unable to tolerate other single tablet regimens.

Please remember to talk with your provider or pharmacist if you want to know more about single tablet regimens.