Question: I am taking Atripla for HIV infection and recently started taking adrafinil (Olmifon) which is a prodrug to modafinil (provigil). In doing some research I've found that modafinil can accelerated the metabolism of efavirenz (the sustiva portion of the atripla) and possibly lower serum levels. This is listed as a minor interaction, however, and I've had advice that it won't significantly lower serum levels enough to create resistance on the part of HIV. My primary doctor isn't a fan of this class of drugs because of the impact on the liver, but I find it very helpful with my mood and concentration and my psychiatrist is trying to get me insurance clearance or manufacturer assistance on modafinil or armodafinil.
What is your opinion? I would like to continue taking the adrafinil for school but because it undergoes more extensive processing in the liver to create modafinil, I wonder it poses more of a danger to my HIV regimen. I am not sure of the metabolic pathway that transforms adrafinil into modafinil.
Thank you.

thank you very much! In terms of overall liver toxicity--regardless of ART--should I be concerned about long-term use?
actually in your response you mention armodafinil being converted to modafinil, but I am concerned about ADRAFINIL being converted to modafinil and that interference with my ART