ATRIPLA®: A Once-Daily, Fixed-Dose Combination for Effective HIV-1 Management

18 Apr 2025

ATRIPLA® – A Trusted, Once-Daily HIV Treatment

ATRIPLA® combines three proven antiretroviral agents in one convenient, once-daily tablet, offering effective HIV-1 management for treatment-naïve or experienced patients.

What Is ATRIPLA?

ATRIPLA® is a fixed-dose combination antiretroviral medication used for the treatment of HIV-1 infection in adults and children weighing at least 40 kg (88 lbs). It is not a cure for HIV, but it significantly lowers viral load, supports immune function, and reduces the risk of HIV transmission when taken as prescribed.

Composition (Per Tablet)

Efavirenz 600 mg – a non-nucleoside reverse transcriptase inhibitor (NNRTI)
Emtricitabine 200 mg – a nucleoside reverse transcriptase inhibitor (NRTI)
Tenofovir disoproxil fumarate (TDF) 300 mg – a nucleotide reverse transcriptase inhibitor (NtRTI)

Together, these components target HIV replication at multiple stages, making ATRIPLA a strong first-line or continuation therapy option.

Mechanism of Action

Each active ingredient in ATRIPLA plays a specific role:

Efavirenz binds directly to reverse transcriptase, preventing viral DNA synthesis.
Emtricitabine and Tenofovir act as chain terminators—incorporating themselves into viral DNA and halting its elongation.

The result? A significant and sustained reduction in HIV-1 RNA levels.

Indications & Usage

ATRIPLA is indicated as a complete regimen for the treatment of HIV-1 infection in:

Adults and
Pediatric patients weighing ≥40 kg

It is generally used in treatment-naïve individuals, or in those who have achieved virologic suppression on a stable antiretroviral regimen for at least 3 months, and who wish to simplify therapy.

Important Safety Information

Before prescribing or taking ATRIPLA, consider the following:

Contraindications

Known hypersensitivity to any component
Concurrent use with certain medications such as:
- Midazolam, triazolam (risk of prolonged sedation)
- Ergot derivatives
- Voriconazole
- St. John’s Wort

Warnings & Precautions

CNS Effects: Efavirenz can cause dizziness, insomnia, vivid dreams, and depression. Symptoms usually subside over time.
Hepatotoxicity: Monitor liver function tests periodically.
Renal Impairment: Use caution in patients with CrCl < 50 mL/min. Consider alternative regimens.
Bone Mineral Density Loss: TDF has been associated with decreases in BMD. Monitor as clinically appropriate.
Lactic Acidosis and Hepatomegaly with Steatosis: Rare but potentially fatal.

Drug Interactions

Efavirenz is a CYP3A inducer and can interact with many medications, including hormonal contraceptives, antiepileptics, and antifungals. Always review the patient’s full medication list.

Dosing & Administration

Dosage: One tablet (600/200/300 mg) once daily
Administration: Take on an empty stomach, preferably at bedtime to minimize CNS side effects.
Storage: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15–30°C (59–86°F)

Clinical Efficacy

ATRIPLA has been evaluated in several clinical trials demonstrating:

Rapid viral suppression (HIV-1 RNA <50 copies/mL)
Significant increases in CD4+ T-cell counts
Durable efficacy over multiple years
Improved treatment adherence due to once-daily convenience
In treatment-naïve adults, ATRIPLA has shown non-inferiority or superiority compared to other three-drug regimens taken as separate pills.

Patient Benefits

Once-daily dosing = improved adherence
Single-tablet regimen = lower pill burden
Proven durability in virologic suppression
Broad global use = trust and familiarity

Considerations in Special Populations

Pregnancy: Not recommended due to potential teratogenic effects of efavirenz, especially during the first trimester.
Women of childbearing potential: Should use effective contraception and discuss alternatives.
Pediatrics: Safe and effective in patients weighing ≥40 kg.
Elderly: Use with caution in patients ≥65 due to potential for comorbidities and polypharmacy.

Summary

Feature	Details
Formulation	Efavirenz / Emtricitabine / TDF
Dosing	1 tablet daily on an empty stomach
Key Benefit	All-in-one regimen = simplicity & effectiveness
Not for Use In	Pregnancy, severe renal impairment, certain drug interactions
Monitoring	CNS effects, renal function, liver enzymes, BMD

Final Thoughts

ATRIPLA® continues to be a reliable, effective, and well-studied option for HIV-1 treatment. It’s ideal for patients seeking simplified therapy with a long track record of success. As always, treatment should be individualized based on patient-specific factors, comorbidities, and resistance profiles.

For full prescribing information, visit the official FDA label or contact your medical liaison team.