New HIV Drug Leads the Pack
WebMD News Archive
Dec. 15, 1999 (Atlanta) -- A new drug for HIV disease is changing HIV
Until now, the most effective of the so-called drug cocktails designed to
keep HIV in check have contained a class of drugs called protease inhibitors.
But now a member of a new class of drugs -- the non-nucleoside
reverse-transcriptase inhibitors, or NNRTIs -- appears to work better and be
easier to take.
The new NNRTI is Sustiva, also known as efavirenz. The first of two studies
published in TheNew England Journal of Medicine showed that the
drug works better than the protease inhibitor Crixivan (indinavir) when used in
combination with two established HIV drugs (AZT [zidovudine] and 3TC
The second study shows that children as young as 4 years old respond very
well to a cocktail of Sustiva, the protease inhibitor Viracept (nelfinavir),
and at least one drug in the same class as AZT.
"We are really very pleased with the long-term viral suppression,"
Stuart E. Starr, MD, lead author of the pediatric study, tells WebMD. "The
take-home lesson is that this is a very potent combination of antiretroviral
These findings mean that drug combinations including Sustiva are likely to
become the first-line standard of care for both adult and pediatric patients
with early HIV infection.
The published findings show that the Sustiva combinations maintain their
effect for 48 weeks. But in interviews with WebMD, co-authors of both studies
say that among study participants whose HIV viral loads became undetectable
while on combination therapy including Sustiva -- 63% of children and 70% of
adults -- virtually all maintained undetectable viral loads for up to 88
Both studies enrolled patients with relatively early HIV disease with
limited previous exposure to medications. The adults had never received any
NNRTI, any protease inhibitor, or 3TC. Children had never received an NNRTI or
Long-term therapy with protease inhibitors is known to cause problems with
fat metabolism -- often leading to changes in physical appearance -- and
symptoms such as nausea and diarrhea.
Douglas Manion, MD, medical director of DuPont Pharmaceuticals and co-author
of the adult study, was even more enthusiastic about the results. DuPont
manufactures Sustiva. The firm wholly funded the adult study and partially
funded the pediatric study (conducted with the National Institutes of
"Efavirenz in adults has surpassed the current standard of care with
protease inhibitors by 50% and the current standard in children by 100%,"
Manion says. "Anyone who has responded through one year succeeded through
the second year. There are basically no [treatment] failures through the second
Jeffrey Lennox, MD, agrees. "I've seen the study results presented,"
he tells WebMD. "I think people feel the study was well done." He and
his colleagues already are using Sustiva as a first-line therapy for
appropriate patients. "Generally, efavirenz is a good choice for most
patients, but you have to individualize treatment based on their own needs and
treatment history," says Lennox, who is the medical director of the Emory
University infectious disease program at Atlanta's Grady Memorial Hospital.
"We've started quite a few of our children on efavirenz, and one of the
main reasons is it comes in a liquid formulation that children find tolerable.
[The protease inhibitor] ritonavir has a liquid formulation that's very potent,
but you can't get kids to take it."